Provider Demographics
NPI:1194852095
Name:AYTMAN, ANITRA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANITRA
Middle Name:
Last Name:AYTMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:ANITRA
Other - Middle Name:GENEA
Other - Last Name:BILLOPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5380 ROCKROSE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8504
Mailing Address - Country:US
Mailing Address - Phone:559-302-7957
Mailing Address - Fax:
Practice Address - Street 1:597 CENTER AVE STE 150
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4674
Practice Address - Country:US
Practice Address - Phone:925-313-6146
Practice Address - Fax:925-313-6188
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 13956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner