Provider Demographics
NPI:1194917070
Name:MAYBERRY, ANITA (NP)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 DRUMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3120
Mailing Address - Country:US
Mailing Address - Phone:760-371-2128
Mailing Address - Fax:
Practice Address - Street 1:409 DRUMMOND AVE
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3120
Practice Address - Country:US
Practice Address - Phone:760-371-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233954163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics