Provider Demographics
NPI:1942935622
Name:BILLINGSLEA, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BILLINGSLEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HARRISON ST APT C
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2164
Mailing Address - Country:US
Mailing Address - Phone:857-258-7167
Mailing Address - Fax:
Practice Address - Street 1:29 HARRISON ST APT C
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2164
Practice Address - Country:US
Practice Address - Phone:978-697-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8499173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine