Healthcare Provider Details

I. General information

NPI: 1801135116
Provider Name (Legal Business Name): JULIE LORELLE STORELLI FNP, PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE LORELLE SHUTE RN, FNP-C, PA-C

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6137 N THESTA ST STE 101A
FRESNO CA
93710-8605
US

IV. Provider business mailing address

6137 N THESTA ST STE 101A
FRESNO CA
93710-8605
US

V. Phone/Fax

Practice location:
  • Phone: 559-447-9056
  • Fax: 559-447-5768
Mailing address:
  • Phone: 559-447-9056
  • Fax: 559-447-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number604522
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1073131
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: