Provider Demographics
NPI:1316608029
Name:ENNIS, MEGAN ANN (NP)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ANN
Last Name:ENNIS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-665-7200
Mailing Address - Fax:844-720-7885
Practice Address - Street 1:200 N ROBERTSON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1764
Practice Address - Country:US
Practice Address - Phone:310-385-3343
Practice Address - Fax:310-385-3424
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-03-28
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Provider Licenses
StateLicense IDTaxonomies
CA95018844207RH0003X, 207RX0202X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology