MEDICARE: MR. HENRY ASUTIN ANTHONY 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	163W00000X	Registered Nurse	679628	CA
2	363LF0000X	Family Nurse Practitioner	95002187	CA

General Provider Information

NPI Number	:	1881081339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HENRY ASUTIN ANTHONY NP

Provider Business Mailing Address
First Line	:	2339 W CLEVELAND AVE STE 103
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-8765
Country	:	US
Telephone Number	:	559-664-4000
Fax Number	:	559-675-5224

Provider Business Practice Location Address
First Line	:	2339 W CLEVELAND AVE STE 103
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-8765
Country	:	US
Telephone Number	:	559-664-4000
Fax Number	:	559-675-5224

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

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	09/16/2022

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