Provider Demographics
NPI:1629833785
Name:DORCH, ANNA MICHELLE (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MICHELLE
Last Name:DORCH
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MICHELLE
Other - Last Name:CARRARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2248 ELECTRA AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1720
Mailing Address - Country:US
Mailing Address - Phone:805-501-5435
Mailing Address - Fax:
Practice Address - Street 1:2248 ELECTRA AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1720
Practice Address - Country:US
Practice Address - Phone:805-501-5435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95260520163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management