Provider Demographics
NPI:1699989863
Name:GILLCHREST, ANITA LORAINE (RN, PNP)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:LORAINE
Last Name:GILLCHREST
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:MOBLEY
Other - Last Name:GILLCHREST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, PNP
Mailing Address - Street 1:840 RUTHUPHAM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2354
Mailing Address - Country:US
Mailing Address - Phone:619-575-0271
Mailing Address - Fax:
Practice Address - Street 1:4350 OTAY MESA RD
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-1617
Practice Address - Country:US
Practice Address - Phone:619-428-4476
Practice Address - Fax:619-428-6473
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302740163WC1500X, 163WS0200X, 363LP0200X
TX222814363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics