Provider Demographics
NPI:1023406741
Name:LODGE, ANN SR
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:LODGE
Suffix:SR
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 1:15025 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:NY
Mailing Address - Zip Code:13156-3299
Mailing Address - Country:US
Mailing Address - Phone:570-702-3906
Mailing Address - Fax:
Practice Address - Street 1:15025 CENTER RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:NY
Practice Address - Zip Code:13156-3299
Practice Address - Country:US
Practice Address - Phone:570-702-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664054163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse