Healthcare Provider Details

I. General information

NPI: 1437617982
Provider Name (Legal Business Name): BRITTANY MBONG CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N MEDICAL CENTER DR E STE 221
CLOVIS CA
93611-6886
US

IV. Provider business mailing address

726 N MEDICAL CENTER DR E STE 221
CLOVIS CA
93611-6886
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-2900
  • Fax:
Mailing address:
  • Phone: 559-322-2900
  • Fax: 530-758-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95011051
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: