MEDICARE: ANNE H LARRIEUX LPN

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	164W00000X	Licensed Practical Nurse	5175393	FL

General Provider Information

NPI Number	:	1073772448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE H LARRIEUX LPN

Provider Business Mailing Address
First Line	:	PO BOX 848263
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33084-0263
Country	:	US
Telephone Number	:	954-925-1997
Fax Number	:

Provider Business Practice Location Address
First Line	:	3059 RED MANGROVE LN
Second Line	:
City	:	DANIA
State	:	FL
Zip	:	33312-0263
Country	:	US
Telephone Number	:	954-925-1997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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