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General NPI Number Information
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NPI Number | 1770737009
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Entity Type | Individual
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Provider Name | FAWN LYNN MCCLOUD FNP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 750 MASON ST
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City | VACAVILLE
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State | CA
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Zip | 95688-4633
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Country | US
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Telephone | 707-888-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 750 MASON ST STE 128
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City | VACAVILLE
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State | CA
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Zip | 95688-4633
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Country | US
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Telephone | 707-888-8050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NPF12893
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License Number State | CA
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