Provider Demographics
NPI:1093484115
Name:VERNER, ANNA VLADIMIROVNA (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:VLADIMIROVNA
Last Name:VERNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8737 FLETCHER PKWY APT 474
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3237
Mailing Address - Country:US
Mailing Address - Phone:619-496-9685
Mailing Address - Fax:
Practice Address - Street 1:8737 FLETCHER PKWY APT 474
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3237
Practice Address - Country:US
Practice Address - Phone:619-496-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily