MEDICARE: DANI ELLEN NP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	9082	CA

General Provider Information

NPI Number	:	1356680623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANI ELLEN NP

Provider Business Mailing Address
First Line	:	PO BOX 28953
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93729-8953
Country	:	US
Telephone Number	:	559-228-4298
Fax Number	:	559-224-3920

Provider Business Practice Location Address
First Line	:	722 MEDICAL CENTER DR E STE 105
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93611-6810
Country	:	US
Telephone Number	:	559-299-7700
Fax Number	:	559-224-3420

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

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	02/06/2013

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Directions to “ DANI ELLEN NP” Practice Location

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