Individual ProviderViolet WannerNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address10833 Le Conte Ave, Los Angeles, CA 90095-4492(310) 825-0867(303) 670-0647PECOS EnrollmentBased on the most recent information from CMS, provider Violet Wanner does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:47 AM.Profile DetailsProvider ID1851713432Provider TypeIndividualFull NameWanner, VioletGenderFemaleSole ProprietorNoEnumeration Date1/15/2014Last Updated7/21/2022Contact InformationPractice LocationPractice Address10833 Le Conte Ave, Los Angeles, CA 90095-4492Phone(310) 825-0867FaxUnlisted FaxMailing LocationMailing Address5767 W Century Blvd Ste 400, Los Angeles, CA 90045-5631Phone(303) 670-0647FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense95002866CaliforniaCode163WN0002XDescriptionRegistered NurseNursing Service ProvidersLicense104773Colorado