Healthcare Provider Details

I. General information

NPI: 1265560007
Provider Name (Legal Business Name): MALINDA ACKERMAN KRENN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E 13TH ST
MERCED CA
95340-6211
US

IV. Provider business mailing address

2153 BENNINGTON CT
MERCED CA
95340-3375
US

V. Phone/Fax

Practice location:
  • Phone: 209-385-7060
  • Fax:
Mailing address:
  • Phone: 209-722-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN332977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: