Healthcare Provider Details

I. General information

NPI: 1982797239
Provider Name (Legal Business Name): PATHWAYS NURSING PRACTITIONERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 S OAK AVE BLDG.2-1
OAKDALE CA
95361-3528
US

IV. Provider business mailing address

190 S OAK AVE BLDG. 2-1
OAKDALE CA
95361-3528
US

V. Phone/Fax

Practice location:
  • Phone: 209-848-8410
  • Fax: 209-848-0732
Mailing address:
  • Phone: 209-848-8410
  • Fax: 209-848-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberNA
License Number State

VIII. Authorized Official

Name: MARC C STONER
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential: FNP
Phone: 209-848-8410