Healthcare Provider Details

I. General information

NPI: 1427042639
Provider Name (Legal Business Name): JESSICA STENDEL F.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 MEDICAL CENTER DR E SUITE 103
CLOVIS CA
93611-6805
US

IV. Provider business mailing address

PO BOX 28900
FRESNO CA
93729-8900
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2224
  • Fax:
Mailing address:
  • Phone: 559-228-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberZZZ37711Z
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: