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General NPI Number Information
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NPI Number | 1821329491
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Entity Type | Individual
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Provider Name | ANTONIETTA LAVERNE SCULIMBRENE MD
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Gender | Female
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 110 COUNTRY KNL
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-9154
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Country | US
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Telephone | 859-224-9526
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Fax | 859-223-1764
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Provider Business Mailing Address
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Address Line | 110 COUNTRY KNL
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-9154
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Country | US
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Telephone | 859-224-9526
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Fax | 859-223-1764
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 51142
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 28597
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License Number State | KY
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