Provider Demographics
NPI:1487926895
Name:CHESTOVICH, ANN MICHELLE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MICHELLE
Last Name:CHESTOVICH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15477 VENTURA BLVD
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3006
Mailing Address - Country:US
Mailing Address - Phone:310-989-9211
Mailing Address - Fax:818-907-0360
Practice Address - Street 1:15477 VENTURA BLVD
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3006
Practice Address - Country:US
Practice Address - Phone:310-989-9211
Practice Address - Fax:818-907-0360
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA673117363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics