Healthcare Provider Details

I. General information

NPI: 1922586643
Provider Name (Legal Business Name): DEVON LAGRACE CASIDA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 W SHAW AVE STE 103
FRESNO CA
93711-3718
US

IV. Provider business mailing address

1233 W SHAW AVE STE 103
FRESNO CA
93711-3718
US

V. Phone/Fax

Practice location:
  • Phone: 559-284-4794
  • Fax:
Mailing address:
  • Phone: 559-206-7680
  • Fax: 559-206-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009510
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95009510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: