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General NPI Number Information
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NPI Number | 1003162801
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Entity Type | Organization
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Legal Business Name | JASON STUTZMAN
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 1925 E DAKOTA AVE
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City | FRESNO
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State | CA
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Zip | 93726-4821
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Country | US
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Telephone | 559-459-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 E DAKOTA AVE
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City | FRESNO
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State | CA
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Zip | 93726-4821
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. JASON STUTZMAN
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Credential | FNP-BC
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Telephone | 559-321-6211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 21511
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | 21511
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License Number State | CA
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