Healthcare Provider Details

I. General information

NPI: 1841004710
Provider Name (Legal Business Name): ANAIT ANAIS DUDUYAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N VICTORY BLVD STE 105
BURBANK CA
91502-1848
US

IV. Provider business mailing address

8404 WAKEFIELD AVE
PANORAMA CITY CA
91402-3749
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-5020
  • Fax:
Mailing address:
  • Phone: 818-331-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95029219
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number95194429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: