Healthcare Provider Details

I. General information

NPI: 1952382350
Provider Name (Legal Business Name): PAULA S. DUCLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E ALMOND AVE MADERA
MADERA CA
93637-5606
US

IV. Provider business mailing address

1210 E ALMOND AVE MADERA
MADERA CA
93637-5606
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-5555
  • Fax:
Mailing address:
  • Phone: 559-675-5530
  • Fax: 559-675-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number344199
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: