Provider Demographics
NPI:1730526112
Name:LEMON, ANITA M
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:M
Last Name:LEMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5723 HOLIDAY CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70812-2128
Mailing Address - Country:US
Mailing Address - Phone:225-200-6564
Mailing Address - Fax:225-356-4127
Practice Address - Street 1:2138 WOODDALE BLVD
Practice Address - Street 2:BUILDING #B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1443
Practice Address - Country:US
Practice Address - Phone:224-200-6564
Practice Address - Fax:225-356-4127
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2328018146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2328018Medicaid