Healthcare Provider Details

I. General information

NPI: 1184357188
Provider Name (Legal Business Name): GABRIELLA MENDEZ WILSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 05/08/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6095 N 1ST ST
FRESNO CA
93710-5444
US

IV. Provider business mailing address

9807 E BULLARD AVE
CLOVIS CA
93619-8202
US

V. Phone/Fax

Practice location:
  • Phone: 559-446-1515
  • Fax:
Mailing address:
  • Phone: 559-260-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: