Healthcare Provider Details

I. General information

NPI: 1619906989
Provider Name (Legal Business Name): ANDREA L MOUSHIGIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 MEDICAL CENTER DR W SUITE 101
CLOVIS CA
93611-6803
US

IV. Provider business mailing address

9036 N RECREATION AVE
FRESNO CA
93720-4139
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-9300
  • Fax:
Mailing address:
  • Phone: 559-307-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: