MEDICARE: MRS. ANNE LANE SALICE NP

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	F350016	NY

General Provider Information

NPI Number	:	1417115056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE LANE SALICE NP

Provider Business Mailing Address
First Line	:	2120 CROWN LAND LN
Second Line	:
City	:	CUTCHOGUE
State	:	NY
Zip	:	11935-1211
Country	:	US
Telephone Number	:	631-734-5734
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 CROWN LAND LN
Second Line	:
City	:	CUTCHOGUE
State	:	NY
Zip	:	11935-1211
Country	:	US
Telephone Number	:	631-734-5734
Fax Number	:

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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