Provider Demographics
NPI:1417099649
Name:POMPHREY, ANN LLOYD (PNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LLOYD
Last Name:POMPHREY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 COOLIDGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3563
Mailing Address - Country:US
Mailing Address - Phone:626-568-4500
Mailing Address - Fax:626-578-1204
Practice Address - Street 1:1904 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3563
Practice Address - Country:US
Practice Address - Phone:626-568-4500
Practice Address - Fax:626-578-1204
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289375363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics