Provider Demographics
NPI:1295200046
Name:AWATIN, MARYJANE (FNP)
Entity type:Individual
Prefix:
First Name:MARYJANE
Middle Name:
Last Name:AWATIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2055
Mailing Address - Country:US
Mailing Address - Phone:714-319-5800
Mailing Address - Fax:
Practice Address - Street 1:4695 MACARTHUR CT # 1112A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1882
Practice Address - Country:US
Practice Address - Phone:084-446-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010131163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95010131OtherFNP