Provider Demographics
NPI:1578853701
Name:MCNULTY, ANITA CATHERINE (FNP CNM)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:CATHERINE
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:FNP CNM
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:CATHERINE
Other - Last Name:MCWATTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8340 BLACKNEY RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4607
Mailing Address - Country:US
Mailing Address - Phone:707-824-9533
Mailing Address - Fax:
Practice Address - Street 1:8340 BLACKNEY RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4607
Practice Address - Country:US
Practice Address - Phone:707-824-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20593363LF0000X
CANMW853367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife