Provider Demographics
NPI:1598413296
Name:NORMAN, ANNA MICHELLE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MICHELLE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W MAIN ST APT 17
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6836
Mailing Address - Country:US
Mailing Address - Phone:917-716-0726
Mailing Address - Fax:
Practice Address - Street 1:885 SCOTT BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5255
Practice Address - Country:US
Practice Address - Phone:408-663-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist