Healthcare Provider Details

I. General information

NPI: 1013677715
Provider Name (Legal Business Name): TUSWANA MAKINI ELLSBERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST
FRESNO CA
93721-1324
US

IV. Provider business mailing address

7090 N FRUIT AVE APT 140
FRESNO CA
93711-0769
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-6000
  • Fax:
Mailing address:
  • Phone: 559-885-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberNP95018532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: