Healthcare Provider Details

I. General information

NPI: 1962803692
Provider Name (Legal Business Name): GUADALUPE LEMUS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PUTNAM AVE
PORTERVILLE CA
93257-3257
US

IV. Provider business mailing address

590 W PUTNAM AVE
PORTERVILLE CA
93257-3257
US

V. Phone/Fax

Practice location:
  • Phone: 559-781-3700
  • Fax: 559-782-1753
Mailing address:
  • Phone: 559-781-3700
  • Fax: 559-782-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number729722
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: