Provider Demographics
NPI:1265418453
Name:ANTHONY, LISA DAWN
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DAWN
Last Name:ANTHONY
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 1:2301 E FORT MACON RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28512-5633
Mailing Address - Country:US
Mailing Address - Phone:252-241-0670
Mailing Address - Fax:252-240-8447
Practice Address - Street 1:2301 E FORT MACON RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:NC
Practice Address - Zip Code:28512-5633
Practice Address - Country:US
Practice Address - Phone:252-241-0670
Practice Address - Fax:252-240-8447
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other