Healthcare Provider Details

I. General information

NPI: 1033850094
Provider Name (Legal Business Name): ANNA NATWORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17905 FETLOCK DR
RENO NV
89508-6513
US

IV. Provider business mailing address

17905 FETLOCK DR
RENO NV
89508-6513
US

V. Phone/Fax

Practice location:
  • Phone: 775-513-7538
  • Fax:
Mailing address:
  • Phone: 775-513-7538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95067956
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN58020
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: