Provider Demographics
NPI:1053445213
Name:NORTH, NANCY ANN
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:NORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4514
Mailing Address - Country:US
Mailing Address - Phone:619-401-4081
Mailing Address - Fax:619-442-7439
Practice Address - Street 1:270 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4514
Practice Address - Country:US
Practice Address - Phone:619-401-4081
Practice Address - Fax:619-442-7439
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS190181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA718365Medicaid