Healthcare Provider Details

I. General information

NPI: 1033460258
Provider Name (Legal Business Name): WEN FANG YUAN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 E KASHIAN LN SUITE 301
FRESNO CA
93701-2230
US

IV. Provider business mailing address

4910 E CLINTON WAY SUITE 101
FRESNO CA
93727-1560
US

V. Phone/Fax

Practice location:
  • Phone: 559-320-0530
  • Fax: 559-320-0532
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP22274
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number22274
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number515715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: