Healthcare Provider Details

I. General information

NPI: 1295155653
Provider Name (Legal Business Name): PAHOUA XIONG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 SANDPIPER AVE
MERCED CA
95340-8372
US

IV. Provider business mailing address

6068 N WINTON WAY
WINTON CA
95388
US

V. Phone/Fax

Practice location:
  • Phone: 866-682-4842
  • Fax:
Mailing address:
  • Phone: 209-587-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: