Provider Demographics
NPI:1871826362
Name:MEMMO, LUCY ANN (MED)
Entity Type:Individual
Prefix:MS
First Name:LUCY
Middle Name:ANN
Last Name:MEMMO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 DURYEA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1707
Mailing Address - Country:US
Mailing Address - Phone:804-327-0266
Mailing Address - Fax:
Practice Address - Street 1:10301 DURYEA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1707
Practice Address - Country:US
Practice Address - Phone:804-327-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-140514252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency