Provider Demographics
NPI:1629577150
Name:AHEARN, EMANUELA (NP)
Entity Type:Individual
Prefix:
First Name:EMANUELA
Middle Name:
Last Name:AHEARN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EMANUELA
Other - Middle Name:
Other - Last Name:BIRIESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1308 S MASTERSON RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1308 S MASTERSON RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4821
Practice Address - Country:US
Practice Address - Phone:714-588-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008489363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health