Individual
ANNIQUE R BASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
5125 KING COTTON LN, MIDLOTHIAN, VA 23112-2852
(804) 308-3651
Mailing address
5125 KING COTTON LN, MIDLOTHIAN, VA 23112-2852
(804) 308-3651
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
0031005140
VA
376K00000X
Nurse's Aide
Primary
1401141734
VA
Other
Enumeration date
07/08/2011
Last updated
07/26/2011
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