Healthcare Provider Details

I. General information

NPI: 1265173769
Provider Name (Legal Business Name): ANNA L WARTAN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16573 AUBURN RD
GRASS VALLEY CA
95949-8762
US

IV. Provider business mailing address

10850 GOLD CENTER DR STE 325
RANCHO CORDOVA CA
95670-6177
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-0631
  • Fax:
Mailing address:
  • Phone: 530-273-0631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-QVBJMC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: