Provider Demographics
NPI:1558687491
Name:ANDERSON, JEANNE MARIE (LM, CPM)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3964 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5222
Mailing Address - Country:US
Mailing Address - Phone:805-499-1677
Mailing Address - Fax:
Practice Address - Street 1:3964 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5222
Practice Address - Country:US
Practice Address - Phone:805-499-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CALM291176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula