Healthcare Provider Details

I. General information

NPI: 1598928392
Provider Name (Legal Business Name): ANNA MARIE WHITEBREAD RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 SANDALWOOD DR
MODESTO CA
95350-3819
US

IV. Provider business mailing address

1702 SANDALWOOD DR
MODESTO CA
95350-3819
US

V. Phone/Fax

Practice location:
  • Phone: 209-872-6316
  • Fax:
Mailing address:
  • Phone: 209-872-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number411562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: