Provider Demographics
NPI:1073110813
Name:SHUR, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SHUR
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 1:1268 E OHIO AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-3072
Mailing Address - Country:US
Mailing Address - Phone:773-494-9569
Mailing Address - Fax:
Practice Address - Street 1:1268 E OHIO AVE APT 17
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3072
Practice Address - Country:US
Practice Address - Phone:773-494-9569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283400164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse