Healthcare Provider Details

I. General information

NPI: 1962810739
Provider Name (Legal Business Name): NERISSA HUNTER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

886 HAMPTON ST
VACAVILLE CA
95687-8235
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: