Healthcare Provider Details

I. General information

NPI: 1952197832
Provider Name (Legal Business Name): NICHOLE BERUMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E HERNDON AVE
FRESNO CA
93720-3397
US

IV. Provider business mailing address

432 W PRESCOTT AVE
CLOVIS CA
93619-0434
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-3000
  • Fax:
Mailing address:
  • Phone: 707-490-5822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number811372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: