Provider Demographics
NPI:1912136367
Name:LANTERN PROFESSIONAL NURSING AGENCY, P.A.
Entity Type:Organization
Organization Name:LANTERN PROFESSIONAL NURSING AGENCY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:CHUKWUDI
Authorized Official - Last Name:ACHONU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-278-7666
Mailing Address - Street 1:1073 BULLARD CT
Mailing Address - Street 2:D
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6801
Mailing Address - Country:US
Mailing Address - Phone:919-278-7666
Mailing Address - Fax:919-521-5774
Practice Address - Street 1:1073 BULLARD CT
Practice Address - Street 2:D
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6801
Practice Address - Country:US
Practice Address - Phone:919-278-7666
Practice Address - Fax:919-521-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care