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General NPI Number Information
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NPI Number | 1912724550
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Entity Type | Individual
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Provider Name | MARYANN PRINCE LVN
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Gender | Female
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 1202 APOLLO WAY
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City | SANTA ROSA
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State | CA
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Zip | 95407-6777
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Country | US
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Telephone | 707-565-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 8974 FAIRWAY DR
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City | KELSEYVILLE
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State | CA
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Zip | 95451-9561
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Country | US
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Telephone | 707-791-6882
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 275588
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License Number State | CA
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