MEDICARE: MEDAMERICA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	9936	CA

General Provider Information

NPI Number	:	1861696023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDAMERICA

Provider Business Mailing Address
First Line	:	5512 W OAK AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722
Country	:	US
Telephone Number	:	559-917-8043
Fax Number	:

Provider Business Practice Location Address
First Line	:	2174 N ANTIOCH AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-7310
Country	:	US
Telephone Number	:	559-277-9892
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	MS. CONSTANCE ANNEMARIE HARRIS
Credential	:	FNP
Telephone Number	:	559-277-9892

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/21/2008

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Directions to “MEDAMERICA ” Practice Location

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