Healthcare Provider Details

I. General information

NPI: 1730090713
Provider Name (Legal Business Name): LAVONNE FERRAREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 E CLINTON AVE
FRESNO CA
93703-2517
US

IV. Provider business mailing address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax: 559-248-5305
Mailing address:
  • Phone: 559-225-6100
  • Fax: 559-248-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number689922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: