Healthcare Provider Details

I. General information

NPI: 1205042900
Provider Name (Legal Business Name): MICHELLE KATHLEEN GASH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5464 N PALM AVE # 101
FRESNO CA
93704
US

IV. Provider business mailing address

7000 N MCCAMPBELL DR
FRESNO CA
93722-9030
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-3438
  • Fax: 559-432-9279
Mailing address:
  • Phone: 559-355-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number15774
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: