Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A146091 | CA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A146091 | CA |
NPI | 1275928103 |
---|---|
Provider Name | Nicole Mccrory Constantz Jernick |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93721-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 27/06/2019 |