Healthcare Provider Details

I. General information

NPI: 1215063268
Provider Name (Legal Business Name): ANNA MARIE ANTONOWICH MSN, NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE ANTONOWICH-JONSSON MSN, NP-BC

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR STE 207
UKIAH CA
95482-4568
US

IV. Provider business mailing address

260 HOSPITAL DR STE 207
UKIAH CA
95482-4568
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-7627
  • Fax: 707-463-7420
Mailing address:
  • Phone: 707-463-7627
  • Fax: 707-463-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: