Healthcare Provider Details

I. General information

NPI: 1730526112
Provider Name (Legal Business Name): MRS. ANITA M. LEMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2013
Last Update Date: 05/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 WOODDALE BLVD BUILDING #B
BATON ROUGE LA
70806-1443
US

IV. Provider business mailing address

5723 HOLIDAY CT
BATON ROUGE LA
70812-2128
US

V. Phone/Fax

Practice location:
  • Phone: 224-200-6564
  • Fax: 225-356-4127
Mailing address:
  • Phone: 225-200-6564
  • Fax: 225-356-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number2328018
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: