Provider Demographics
NPI:1386931582
Name:BASTON, ANNIQUE R (CNA)
Entity type:Individual
Prefix:
First Name:ANNIQUE
Middle Name:R
Last Name:BASTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 KING COTTON LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2852
Mailing Address - Country:US
Mailing Address - Phone:804-308-3651
Mailing Address - Fax:
Practice Address - Street 1:5125 KING COTTON LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2852
Practice Address - Country:US
Practice Address - Phone:804-308-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401141734376K00000X
VA0031005140374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374700000XNursing Service Related ProvidersTechnician