Provider Demographics
NPI:1477955607
Name:IANNITTO, ANN ELIZABETH
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:IANNITTO
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:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-815-5190
Mailing Address - Fax:910-815-0840
Practice Address - Street 1:2221 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7542
Practice Address - Country:US
Practice Address - Phone:910-815-5190
Practice Address - Fax:910-815-0840
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC935367A00000X
CA235673367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife