Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Waverly Anne Datner

Individual provider Physician Assistant · NPI 1568197143

Waverly Anne Datner is a Physician Assistant in Los Angeles, California. Qualified in 2023, 3 years ago. Practices with St John's Community Health, a 148-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
3
Licensed in
CA
In the registry since
2022
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Practice location Address checks out

808 W 58th St
Los Angeles, CA 90037-3632
Phone: (323) 541-1411
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA63706 (CA)

Record details

NPI number1568197143
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 19, 2022
Last updated in NPPESDecember 15, 2023
Certification dateDecember 15, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice St. John'S Community Health — 148 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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