Healthcare Provider Details

I. General information

NPI: 1003969700
Provider Name (Legal Business Name): MARILYN BOKEMEIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E DAKOTA AVE ROOM 230
FRESNO CA
93726-4804
US

IV. Provider business mailing address

2025 E DAKOTA AVE RM 230
FRESNO CA
93726-4804
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-5755
  • Fax: 559-453-4736
Mailing address:
  • Phone: 559-453-5755
  • Fax: 559-453-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number391947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: