MEDICARE: PA VUE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	95128778	CA
2	163WP2201X	Ambulatory Care Registered Nurse	95128778	CA
3	163W00000X	Registered Nurse	95128778	CA

General Provider Information

NPI Number	:	1326858853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PA VUE RN

Provider Business Mailing Address
First Line	:	2705 N CARRIAGE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-0957
Country	:	US
Telephone Number	:	559-478-3736
Fax Number	:

Provider Business Practice Location Address
First Line	:	5108 E CLINTON WAY STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-2043
Country	:	US
Telephone Number	:	559-478-3736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	03/13/2025

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Directions to “ PA VUE RN” Practice Location

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