Healthcare Provider Details

I. General information

NPI: 1851627459
Provider Name (Legal Business Name): PATRICIA J WEATHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4762 W JENNIFER AVE STE 102
FRESNO CA
93722-6423
US

IV. Provider business mailing address

4762 W JENNIFER AVE STE 102
FRESNO CA
93722-6423
US

V. Phone/Fax

Practice location:
  • Phone: 623-247-2182
  • Fax:
Mailing address:
  • Phone: 623-247-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN176064
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberLP036459
License Number StateAZ

VIII. Authorized Official

Name: MRS. PATRICIA J WEATHINGTON
Title or Position: HEALTH MINISTER/ PASTORAL COUNSELOR
Credential: LPN
Phone: 623-247-2182