Provider Demographics
NPI:1326672940
Name:PEDLAR, ANNIE ROSE (FNP, DNP)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:ROSE
Last Name:PEDLAR
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2883
Mailing Address - Country:US
Mailing Address - Phone:415-246-3417
Mailing Address - Fax:
Practice Address - Street 1:2121 HARRISON ST STE 120
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3788
Practice Address - Country:US
Practice Address - Phone:510-587-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily