Provider Demographics
NPI:1285840116
Name:IANNOTTI, NANCY M (RNP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:IANNOTTI
Suffix:
Gender:F
Credentials:RNP-C
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:BEAUMONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP-C
Mailing Address - Street 1:7440 LAURA ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2106
Mailing Address - Country:US
Mailing Address - Phone:562-927-9095
Mailing Address - Fax:562-927-8603
Practice Address - Street 1:6501 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1805
Practice Address - Country:US
Practice Address - Phone:562-928-9600
Practice Address - Fax:562-927-8603
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369988261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP52384Medicare UPIN
CAWNP6049AMedicare ID - Type UnspecifiedMEDICARE