MEDICARE: PRISCILLA MA

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	163W00000X	Registered Nurse	95386153	CA

General Provider Information

NPI Number	:	1801723234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA MA

Provider Business Mailing Address
First Line	:	633 N VAN NESS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93728-3421
Country	:	US
Telephone Number	:	559-441-2797
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 N VAN NESS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93728-3421
Country	:	US
Telephone Number	:	559-441-2797
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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Directions to “ PRISCILLA MA ” Practice Location

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