Provider Demographics
NPI:1013329010
Name:ANTHON, LUCILLE ROSALIND (LPN)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:ROSALIND
Last Name:ANTHON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CLAY AVE
Mailing Address - Street 2:APARTMENT 4M
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1775
Mailing Address - Country:US
Mailing Address - Phone:347-862-1258
Mailing Address - Fax:
Practice Address - Street 1:1450 CLAY AVE
Practice Address - Street 2:APARTMENT 4M
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1775
Practice Address - Country:US
Practice Address - Phone:347-862-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318457-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse