Healthcare Provider Details

I. General information

NPI: 1477532034
Provider Name (Legal Business Name): MARLA PETERSON FNP/PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 N ACACIA AVE SUITE 101
REEDLEY CA
93654-2102
US

IV. Provider business mailing address

1419 N ACACIA AVE STE 101
REEDLEY CA
93654-2197
US

V. Phone/Fax

Practice location:
  • Phone: 559-391-3160
  • Fax: 559-391-3162
Mailing address:
  • Phone: 559-391-3160
  • Fax: 559-391-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16472
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP13760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: