Healthcare Provider Details

I. General information

NPI: 1942426960
Provider Name (Legal Business Name): NANCY ANDERSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N BRENT ST SUITE 405
VENTURA CA
93003-2817
US

IV. Provider business mailing address

168 N BRENT ST SUITE 405
VENTURA CA
93003-2817
US

V. Phone/Fax

Practice location:
  • Phone: 805-667-3909
  • Fax: 805-667-3915
Mailing address:
  • Phone: 805-667-3909
  • Fax: 805-667-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number254153
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number31
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: