Provider Demographics
NPI:1962478479
Name:MCGOWAN, ANETTE (NP-C, RN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:ANETTE
Middle Name:
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:NP-C, RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79430 HIGHWAY 111
Mailing Address - Street 2:101
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4549
Mailing Address - Country:US
Mailing Address - Phone:760-564-3533
Mailing Address - Fax:760-564-3360
Practice Address - Street 1:79430 HIGHWAY 111 STE 101
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4549
Practice Address - Country:US
Practice Address - Phone:760-564-3533
Practice Address - Fax:760-564-3360
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11390364SN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SN0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeuroscience
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1680ZOtherPTAN
CAE1680ZOtherPTAN