Provider Demographics
NPI:1609050681
Name:COVERDELL, MARY ANN (RN APN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:COVERDELL
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Gender:F
Credentials:RN APN
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2726
Mailing Address - Fax:916-853-7874
Practice Address - Street 1:7115 GREENBACK LN
Practice Address - Street 2:FL 2
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-6133
Practice Address - Country:US
Practice Address - Phone:916-536-3620
Practice Address - Fax:916-536-3541
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2020-03-16
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Provider Licenses
StateLicense IDTaxonomies
CA18626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA160905681Medicaid
CA160905681Medicaid