Basic Information
| Provider Information | |||||||||
| NPI: | 1740930049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | DOVIE | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 CAMINO DEL ORO | ||||||||
| Address2: | |||||||||
| City: | RANCHO SANTA MARGARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926883165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609879100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20331 FLANAGAN ROAD | ||||||||
| Address2: | |||||||||
| City: | TRABUCO CANYON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185828832 | ||||||||
| FaxNumber: | 8185828836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2022 | ||||||||
| LastUpdateDate: | 03/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 276368 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.