Provider Demographics
NPI:1194116145
Name:ANTHONY, LORRAINE (CRNA)
Entity type:Individual
Prefix:MISS
First Name:LORRAINE
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 GOLDSBORO RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5826
Mailing Address - Country:US
Mailing Address - Phone:301-263-0800
Mailing Address - Fax:301-263-0820
Practice Address - Street 1:6400 GOLDSBORO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-5826
Practice Address - Country:US
Practice Address - Phone:301-263-0800
Practice Address - Fax:301-263-0820
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172346367500000X
MDR171857367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered