Healthcare Provider Details

I. General information

NPI: 1285062505
Provider Name (Legal Business Name): EMILY BAHNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N WAYTE LN
FRESNO CA
93701-2124
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4300
  • Fax: 559-459-4569
Mailing address:
  • Phone: 559-453-5200
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP23161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: