Provider Demographics
NPI:1457549735
Name:SHAH, ANNEMARIE (LVN)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24023 CAPE MAY CT
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3317
Mailing Address - Country:US
Mailing Address - Phone:661-290-2409
Mailing Address - Fax:
Practice Address - Street 1:6931 VAN NUYS BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3937
Practice Address - Country:US
Practice Address - Phone:818-374-6901
Practice Address - Fax:818-373-4830
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS113692164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7322-AOtherCOUNTY PROVIDER