Healthcare Provider Details

I. General information

NPI: 1669509923
Provider Name (Legal Business Name): FATMATA NANCY LONGSTRETH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATMATA NANCY LONGSTRETH RN

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2366 WINCHESTER LOOP
DISCOVERY BAY CA
94514-1855
US

IV. Provider business mailing address

100 WARD STREET
MARTINEZ CA
94553
US

V. Phone/Fax

Practice location:
  • Phone: 925-335-4707
  • Fax: 925-335-4718
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number548100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: