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
1	291U00000X	Clinical 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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