Healthcare Provider Details

I. General information

NPI: 1124575261
Provider Name (Legal Business Name): MARGO MARIE LELLA APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGO MARIE BECKER APRN, FNP

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N SEE VEE LN
BISHOP CA
93514-8130
US

IV. Provider business mailing address

250 N SEE VEE LN
BISHOP CA
93514-8130
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-8461
  • Fax: 760-873-3908
Mailing address:
  • Phone: 760-873-8461
  • Fax: 760-873-3908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021401
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95068616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: