Provider Demographics
NPI:1285716894
Name:WASHINGTON, ANITRA GAIL (LPN)
Entity type:Individual
Prefix:
First Name:ANITRA
Middle Name:GAIL
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:WILMAR
Mailing Address - State:AZ
Mailing Address - Zip Code:71675
Mailing Address - Country:US
Mailing Address - Phone:870-469-5006
Mailing Address - Fax:870-367-0348
Practice Address - Street 1:790 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655
Practice Address - Country:US
Practice Address - Phone:870-367-2461
Practice Address - Fax:870-367-0348
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL43440164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse