Healthcare Provider Details

I. General information

NPI: 1053829085
Provider Name (Legal Business Name): MARCY LATHROP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6095 N 1ST ST
FRESNO CA
93710-5444
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 559-446-1515
  • Fax: 559-446-1273
Mailing address:
  • Phone: 408-795-3619
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: