Provider Demographics
NPI:1023496692
Name:RABBANI, ADRIENNE MICHELLE (CRNA)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MICHELLE
Last Name:RABBANI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16110 VENTURA BLVD APT 405
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2536
Mailing Address - Country:US
Mailing Address - Phone:910-274-5193
Mailing Address - Fax:
Practice Address - Street 1:16110 VENTURA BLVD APT 405
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:910-274-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA749806163W00000X
CA95000408367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse