Provider Demographics
NPI:1821329491
Name:SCULIMBRENE, ANTONIETTA LAVERNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIETTA
Middle Name:LAVERNE
Last Name:SCULIMBRENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COUNTRY KNL
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9154
Mailing Address - Country:US
Mailing Address - Phone:859-224-9526
Mailing Address - Fax:859-223-1764
Practice Address - Street 1:110 COUNTRY KNL
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9154
Practice Address - Country:US
Practice Address - Phone:859-224-9526
Practice Address - Fax:859-223-1764
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH51142207L00000X
KY28597207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology