Provider Demographics
NPI:1215063268
Name:ANTONOWICH, ANNA MARIE (MSN, NP-BC)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:ANTONOWICH
Suffix:
Gender:F
Credentials:MSN, NP-BC
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:ANTONOWICH-JONSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP-BC
Mailing Address - Street 1:260 HOSPITAL DR STE 207
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4568
Mailing Address - Country:US
Mailing Address - Phone:707-463-7627
Mailing Address - Fax:707-463-7420
Practice Address - Street 1:260 HOSPITAL DR STE 207
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4568
Practice Address - Country:US
Practice Address - Phone:707-463-7627
Practice Address - Fax:707-463-7420
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily