Provider Demographics
NPI:1003106386
Name:LIM, MARLENE SOLOMON (PNP)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:SOLOMON
Last Name:LIM
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 E KINGS CANYON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4744
Mailing Address - Country:US
Mailing Address - Phone:559-255-7777
Mailing Address - Fax:559-454-1091
Practice Address - Street 1:5755 E KINGS CANYON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4744
Practice Address - Country:US
Practice Address - Phone:559-255-7777
Practice Address - Fax:559-454-1091
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429173363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics