Healthcare Provider Details

I. General information

NPI: 1326858853
Provider Name (Legal Business Name): PA VUE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 E CLINTON WAY STE 107
FRESNO CA
93727-2043
US

IV. Provider business mailing address

2705 N CARRIAGE AVE
FRESNO CA
93727-0957
US

V. Phone/Fax

Practice location:
  • Phone: 559-478-3736
  • Fax:
Mailing address:
  • Phone: 559-478-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95128778
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95128778
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95128778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: