Healthcare Provider Details

I. General information

NPI: 1306942917
Provider Name (Legal Business Name): ANNE B MENZIES RN,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

26302 LA PAZ RD 206
MISSION VIEJO CA
92691-5313
US

IV. Provider business mailing address

22212 SHADE TREE LN
LAKE FOREST CA
92630-3321
US

V. Phone/Fax

Practice location:
  • Phone: 949-768-3643
  • Fax: 949-768-5660
Mailing address:
  • Phone: 949-830-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number250066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: