Healthcare Provider Details

I. General information

NPI: 1861800971
Provider Name (Legal Business Name): ANNITA MAE CLINE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 HERNDON AVE STE 105
CLOVIS CA
93611-6307
US

IV. Provider business mailing address

2151 HERNDON AVE 105
CLOVIS CA
93611-6307
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-7563
  • Fax:
Mailing address:
  • Phone: 559-355-8965
  • Fax: 559-625-7533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: