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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P., R.N.

Contact information

Practice address
3812 N 1ST ST, FRESNO, CA 93726-4301
(559) 495-3120
(559) 495-3134
Mailing address
7055 N MAPLE AVE, 106, FRESNO, CA 93720-8012
(559) 797-9800
(559) 797-0140

Taxonomy

Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
NP 5754
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NP 5754
NURSE PRACT LICENSE #
CA
01
RN 271957
RN LICENSE #
CA
Enumeration date
03/23/2007
Last updated
05/30/2013
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