Healthcare Provider Details

I. General information

NPI: 1023255841
Provider Name (Legal Business Name): MECHELLE RENEE PEREA-RYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MECHELLE RENEE PEREA FNP

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 LAS VEGAS ST
MODESTO CA
95358-5500
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-4200
  • Fax: 209-556-5064
Mailing address:
  • Phone: 209-383-1848
  • Fax: 209-383-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN445148
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP9455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: