Healthcare Provider Details

I. General information

NPI: 1942822853
Provider Name (Legal Business Name): JENNIFER HER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST STE 162
FRESNO CA
93726-6869
US

IV. Provider business mailing address

258 N BLACKSTONE AVE
FRESNO CA
93701-1913
US

V. Phone/Fax

Practice location:
  • Phone: 559-476-2166
  • Fax:
Mailing address:
  • Phone: 559-274-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number694807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: