Provider Demographics
NPI:1093413437
Name:KECHICHIAN, NANOR MARY (FNP-C)
Entity Type:Individual
Prefix:
First Name:NANOR
Middle Name:MARY
Last Name:KECHICHIAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W LA VETA AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4439
Mailing Address - Country:US
Mailing Address - Phone:714-711-8006
Mailing Address - Fax:
Practice Address - Street 1:725 W LA VETA AVE STE 260
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4439
Practice Address - Country:US
Practice Address - Phone:714-711-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily