Healthcare Provider Details

I. General information

NPI: 1245075159
Provider Name (Legal Business Name): MARY LYN FLEURIMOND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 HOSPITAL DR STE 211
MOUNTAIN VIEW CA
94040-4125
US

IV. Provider business mailing address

PO BOX 342
SAN JOSE CA
95103-0342
US

V. Phone/Fax

Practice location:
  • Phone: 650-988-7781
  • Fax:
Mailing address:
  • Phone: 561-866-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number758391
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95025751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: