Provider Demographics
NPI:1659640068
Name:BACKER, ANITA (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BACKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:KORNGOLD
Other - Last Name:BACKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:109 BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3901
Mailing Address - Country:US
Mailing Address - Phone:510-654-7093
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4301
Practice Address - Country:US
Practice Address - Phone:510-642-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332974163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care