Provider Demographics
NPI:1184282667
Name:MUDRINICH, ANNE MARIE (FNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MUDRINICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:JASINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:509 SHEHY GLEN PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7604
Mailing Address - Country:US
Mailing Address - Phone:916-303-6082
Mailing Address - Fax:
Practice Address - Street 1:508 GIBSON DR STE 220
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5796
Practice Address - Country:US
Practice Address - Phone:917-773-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner