Provider Demographics
NPI:1811045354
Name:FERNANDEZ, ANN MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1540 FLORIDA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-544-3236
Mailing Address - Fax:209-577-8125
Practice Address - Street 1:1540 FLORIDA AVE
Practice Address - Street 2:STE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-544-3236
Practice Address - Fax:209-577-8125
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320561163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse