Provider Demographics
NPI:1578289625
Name:SCHALLERER, ANNALISA ELIZABETH (MSN, APRN, WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ANNALISA
Middle Name:ELIZABETH
Last Name:SCHALLERER
Suffix:
Gender:F
Credentials:MSN, APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49-111 CA-111 6A
Mailing Address - Street 2:UNIT 6 STE
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49-111 CA-111 S
Practice Address - Street 2:UNIT 6A
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236
Practice Address - Country:US
Practice Address - Phone:888-743-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95302471163W00000X
CANP95022776363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
104148185OtherNATIONAL CERTIFICATION CORPORATION
CANP95022776OtherCA STATE LICENSE - NURSE PRACTITIONER