Healthcare Provider Details

I. General information

NPI: 1356680623
Provider Name (Legal Business Name): DANI ELLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MEDICAL CENTER DR E STE 105
CLOVIS CA
93611-6810
US

IV. Provider business mailing address

PO BOX 28953
FRESNO CA
93729-8953
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-7700
  • Fax: 559-224-3420
Mailing address:
  • Phone: 559-228-4298
  • Fax: 559-224-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number9082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: