Healthcare Provider Details

I. General information

NPI: 1023496692
Provider Name (Legal Business Name): ADRIENNE MICHELLE RABBANI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16110 VENTURA BLVD APT 405
ENCINO CA
91436
US

IV. Provider business mailing address

16110 VENTURA BLVD APT 405
ENCINO CA
91436-2536
US

V. Phone/Fax

Practice location:
  • Phone: 910-274-5193
  • Fax:
Mailing address:
  • Phone: 910-274-5193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number749806
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: