Healthcare Provider Details

I. General information

NPI: 1902485667
Provider Name (Legal Business Name): ALEXIS E MASSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5464 N PALM AVE STE A
FRESNO CA
93704-1946
US

IV. Provider business mailing address

349 E BULLARD AVE STE 105
FRESNO CA
93710-5298
US

V. Phone/Fax

Practice location:
  • Phone: 559-238-7164
  • Fax:
Mailing address:
  • Phone: 559-272-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95016808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: