1992855514 NPI number — TOWER CLINIC FOR WOMEN AND CHILDREN A NURSE PRACTIONER AND NURSING MID

Table of content: (NPI 1992855514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992855514 NPI number — TOWER CLINIC FOR WOMEN AND CHILDREN A NURSE PRACTIONER AND NURSING MID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWER CLINIC FOR WOMEN AND CHILDREN A NURSE PRACTIONER AND NURSING MID
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992855514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1277 N WISHON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93728-2346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-264-7059
Provider Business Mailing Address Fax Number:
559-264-7057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1277 N WISHON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93728-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-264-7059
Provider Business Practice Location Address Fax Number:
559-264-7057
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ISTVANICK
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
559-264-7062

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  RN479392 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G692111 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ178947 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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