Healthcare Provider Details

I. General information

NPI: 1811686991
Provider Name (Legal Business Name): LIGHT CARE NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4944 E CLINTON WAY STE 107
FRESNO CA
93727-1527
US

IV. Provider business mailing address

4944 E CLINTON WAY STE 107
FRESNO CA
93727-1527
US

V. Phone/Fax

Practice location:
  • Phone: 951-801-2819
  • Fax: 951-269-4064
Mailing address:
  • Phone: 951-801-2819
  • Fax: 951-269-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHIKA AGULANNA
Title or Position: PMHNP
Credential: NP
Phone: 951-441-9846