Provider Demographics
NPI:1629279401
Name:VAWTER, BETH ANN (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:VAWTER
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 SHAMROCK AVENUE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784
Mailing Address - Country:US
Mailing Address - Phone:909-985-6090
Mailing Address - Fax:
Practice Address - Street 1:170 W SAN JOSE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5285
Practice Address - Country:US
Practice Address - Phone:909-398-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily