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General NPI Number Information
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NPI Number | 1407554652
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Entity Type | Organization
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Legal Business Name | MARIPOSA WELLNESS, A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 5074 JONES ST
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City | MARIPOSA
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State | CA
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Zip | 95338
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Country | US
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Telephone | 209-718-5150
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Fax | 209-718-5155
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Provider Business Mailing Address
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Address Line | PO BOX 834
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City | MARIPOSA
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State | CA
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Zip | 95338-0834
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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 | CEO
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Name | HANNAH FOUCH
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Credential | FNP-BC
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Telephone | 209-769-4015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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