Healthcare Provider Details

I. General information

NPI: 1699989863
Provider Name (Legal Business Name): ANITA LORAINE GILLCHREST R.N., P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA MOBLEY GILLCHREST R.N., P.N.P

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 OTAY MESA RD
SAN YSIDRO CA
92173-1617
US

IV. Provider business mailing address

840 RUTHUPHAM AVE
SAN DIEGO CA
92154-2354
US

V. Phone/Fax

Practice location:
  • Phone: 619-428-4476
  • Fax: 619-428-6473
Mailing address:
  • Phone: 619-575-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number302740
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number302740
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number302740
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number222814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: