Healthcare Provider Details

I. General information

NPI: 1194728477
Provider Name (Legal Business Name): MARY V. COLLIGNON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 JAMES ST
SHAFTER CA
93263-2033
US

IV. Provider business mailing address

659 S CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1814
  • Fax: 661-459-1821
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF4036
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN364116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: