Healthcare Provider Details

I. General information

NPI: 1689770927
Provider Name (Legal Business Name): ANN EVERETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 COMPTON AVENUE
LOS ANGELES CA
90002-3628
US

IV. Provider business mailing address

950 NORTH CORONEL COURT
WALNUT CA
91789-4326
US

V. Phone/Fax

Practice location:
  • Phone: 323-568-3005
  • Fax: 323-564-5028
Mailing address:
  • Phone: 626-810-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number268114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: