MEDICARE: MS. LINNEA P. FAETH 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	363L00000X	Nurse Practitioner	200572	CA

General Provider Information

NPI Number	:	1578601456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINNEA P. FAETH NP

Provider Business Mailing Address
First Line	:	4325 W FREMONT AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-9783
Country	:	US
Telephone Number	:	559-432-2463
Fax Number	:	559-431-4721

Provider Business Practice Location Address
First Line	:	7011 N HOWARD ST
Second Line	:	#201
City	:	FRESNO
State	:	CA
Zip	:	93720-2955
Country	:	US
Telephone Number	:	559-431-9571
Fax Number	:	559-431-4721

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	06/27/2012

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