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General NPI Number Information
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NPI Number | 1184282667
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Entity Type | Individual
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Provider Name | ANNE MARIE MUDRINICH FNP
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Gender | Female
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 508 GIBSON DR STE 220
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City | ROSEVILLE
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State | CA
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Zip | 95678-5796
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Country | US
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Telephone | 917-773-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 509 SHEHY GLEN PL
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City | LINCOLN
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State | CA
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Zip | 95648-7604
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Country | US
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Telephone | 916-303-6082
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95009800
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License Number State | CA
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