Provider Demographics
NPI:1962148163
Name:BIRK, ANITA M (LPN)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:BIRK
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 1:419 NORTH JAMES ROAD
Mailing Address - Street 2:COMMUNITY CARE DEPARTMENT
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219
Mailing Address - Country:US
Mailing Address - Phone:614-257-5200
Mailing Address - Fax:614-388-7457
Practice Address - Street 1:419 NORTH JAMES ROAD
Practice Address - Street 2:COMMUNITY CARE DEPARTMENT
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:614-257-5200
Practice Address - Fax:614-388-7457
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.168615.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse