Healthcare Provider Details

I. General information

NPI: 1649228867
Provider Name (Legal Business Name): LAURA KAY VICARS BUSBY RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CA STATE UNIVERSITY FRESNO 5044 N. BARTON AVE MS HC81
FRESNO CA
93740-0001
US

IV. Provider business mailing address

9262 N DEARING AVE
FRESNO CA
93720-4433
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-6722
  • Fax:
Mailing address:
  • Phone: 559-433-1651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 538659 NP 9549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: