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NPI Code Detail

MEDICARE: ANTRAMESE CARRY LVN

MEDICARE:   ANTRAMESE  CARRY  LVN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1003569641
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTRAMESE CARRY LVN
Provider Business Mailing Address
First Line : 4670 CORLEY ST
Second Line :
City : BEAUMONT
State : TX
Zip : 77707-4221
Country : US
Telephone Number : 409-455-2762
Fax Number :
Provider Business Practice Location Address
First Line : 4670 CORLEY ST
Second Line :
City : BEAUMONT
State : TX
Zip : 77707-4221
Country : US
Telephone Number : 409-455-2762
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2022
Last Update Date : 02/02/2022

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Directions to “ ANTRAMESE CARRY LVN” Practice Location

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