MEDICARE: MRS. CARLYE NICOLE WARD 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	363LF0000X	Family Nurse Practitioner	95009444	CA

General Provider Information

NPI Number	:	1760969174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLYE NICOLE WARD NP

Provider Business Mailing Address
First Line	:	3693 N DOUGLAS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-7985
Country	:	US
Telephone Number	:	559-348-9255
Fax Number	:

Provider Business Practice Location Address
First Line	:	9483 N FORT WASHINGTON RD STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-5938
Country	:	US
Telephone Number	:	559-439-1835
Fax Number	:	559-439-3936

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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