Healthcare Provider Details

I. General information

NPI: 1639686132
Provider Name (Legal Business Name): NICOLE CLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 03/01/2020
Certification Date: 03/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 W SHAW AVE # 107
FRESNO CA
93711-3229
US

IV. Provider business mailing address

4205 W FIGARDEN DR
FRESNO CA
93722-6051
US

V. Phone/Fax

Practice location:
  • Phone: 559-476-2115
  • Fax:
Mailing address:
  • Phone: 559-221-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: