Healthcare Provider Details

I. General information

NPI: 1023183969
Provider Name (Legal Business Name): MAUREEN B FRANK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 RENNER DR
FORTUNA CA
95540-3120
US

IV. Provider business mailing address

670 9TH STREET SUITE 203
ARCATA CA
95521-6249
US

V. Phone/Fax

Practice location:
  • Phone: 707-725-6101
  • Fax: 707-725-2978
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPF7882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: