Healthcare Provider Details

I. General information

NPI: 1790526648
Provider Name (Legal Business Name): MAMTA RANI BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6837 E MICHIGAN AVE
FRESNO CA
93727-1451
US

IV. Provider business mailing address

6837 E MICHIGAN AVE
FRESNO CA
93727-1451
US

V. Phone/Fax

Practice location:
  • Phone: 559-389-3971
  • Fax:
Mailing address:
  • Phone: 559-389-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number751584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: