Healthcare Provider Details

I. General information

NPI: 1700407426
Provider Name (Legal Business Name): JOAN N NUNOO AG-PCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN NAA LAMILEY NUNOO DAMSON

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 W HERNDON AVE STE 101
FRESNO CA
93711-7118
US

IV. Provider business mailing address

1332 W HERNDON AVE STE 101
FRESNO CA
93711-7118
US

V. Phone/Fax

Practice location:
  • Phone: 559-277-6570
  • Fax: 559-277-6577
Mailing address:
  • Phone: 559-277-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number238737
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95017523
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number238737
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95017523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: