Provider Demographics
NPI:1326047499
Name:BAVIN, ROBERTA ANNE (CPNP)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:ANNE
Last Name:BAVIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BARSTOW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-2228
Mailing Address - Country:US
Mailing Address - Phone:559-327-7976
Mailing Address - Fax:559-327-7974
Practice Address - Street 1:510 BARSTOW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-2228
Practice Address - Country:US
Practice Address - Phone:559-327-7976
Practice Address - Fax:559-327-7974
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN262580363LP0200X
CANPF 5669363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics