Provider Demographics
NPI:1851398002
Name:MCCONNAUGHEY, ANNETTE LOUISE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:LOUISE
Last Name:MCCONNAUGHEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:ANNETTE
Other - Middle Name:LOUISE
Other - Last Name:EASTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:17360 BROOKHURST ST
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18035 BROOKHURST STREET
Practice Address - Street 2:SUITE 2100
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:657-241-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264527176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW005540OtherMEDICAL
CA002645270OtherMEDI CAL