Healthcare Provider Details

I. General information

NPI: 1700179561
Provider Name (Legal Business Name): NANCY HORNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 15TH ST
MERCED CA
95341-6217
US

IV. Provider business mailing address

2072 NEBELA DR
ATWATER CA
95301-2551
US

V. Phone/Fax

Practice location:
  • Phone: 209-981-6879
  • Fax: 209-725-3775
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number771921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: