Healthcare Provider Details

I. General information

NPI: 1821885278
Provider Name (Legal Business Name): BREANNE CATHLEEN BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N FULTON ST
FRESNO CA
93728
US

IV. Provider business mailing address

1206 W STUART AVE
FRESNO CA
93711-2041
US

V. Phone/Fax

Practice location:
  • Phone: 559-488-4900
  • Fax:
Mailing address:
  • Phone: 559-824-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN95178200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: