Provider Demographics
NPI:1538639919
Name:PEERY, ANNA MARIE (MSN, PHN, WHNP, CNM)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:PEERY
Suffix:
Gender:F
Credentials:MSN, PHN, WHNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13439 BRAZO RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2931
Mailing Address - Country:US
Mailing Address - Phone:951-240-9968
Mailing Address - Fax:
Practice Address - Street 1:800 N STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3547
Practice Address - Country:US
Practice Address - Phone:951-240-9968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010326363LW0102X
CA235983176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health