Provider Demographics
NPI:1386705903
Name:IGAWA, ANN T (NP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:T
Last Name:IGAWA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23388 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2733
Mailing Address - Country:US
Mailing Address - Phone:818-876-1636
Mailing Address - Fax:818-295-3395
Practice Address - Street 1:4323 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4044
Practice Address - Country:US
Practice Address - Phone:818-556-2700
Practice Address - Fax:818-295-3395
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP3569363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP18592Medicare UPIN
CAWNP3569BMedicare ID - Type Unspecified
CAWNP3569AMedicare ID - Type Unspecified
CAWNP3569DMedicare ID - Type Unspecified
CAWNP3569EMedicare ID - Type Unspecified
CAWNP3569CMedicare ID - Type Unspecified