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General NPI Number Information
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NPI Number | 1265263065
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Entity Type | Organization
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Legal Business Name | SIGNATURE PROVIDERS NURSING CORP
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1690 W SHAW AVE STE 220
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City | FRESNO
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State | CA
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Zip | 93711-3519
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Country | US
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Telephone | 888-848-4364
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Fax | 833-218-8844
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Provider Business Mailing Address
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Address Line | PO BOX 392
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City | COALINGA
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State | CA
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Zip | 93210-0392
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Country | US
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Telephone | 888-848-4364
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARK AGANYA
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Credential | PMHNP
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Telephone | 888-848-4364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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