Provider Demographics
NPI:1801765748
Name:MCILWAIN, ANN MARIE
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:MCILWAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76811 USAL RD
Mailing Address - Street 2:
Mailing Address - City:WHITETHORN
Mailing Address - State:CA
Mailing Address - Zip Code:95589-8514
Mailing Address - Country:US
Mailing Address - Phone:707-986-7131
Mailing Address - Fax:707-986-1355
Practice Address - Street 1:76811 USAL RD
Practice Address - Street 2:
Practice Address - City:WHITETHORN
Practice Address - State:CA
Practice Address - Zip Code:95589-8514
Practice Address - Country:US
Practice Address - Phone:707-986-7131
Practice Address - Fax:707-986-1355
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach