Provider Demographics
NPI:1588030597
Name:MACIAS, NANCY (RN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3241 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6069
Mailing Address - Country:US
Mailing Address - Phone:559-305-5508
Mailing Address - Fax:
Practice Address - Street 1:3241 MAGNOLIA
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-9606
Practice Address - Country:US
Practice Address - Phone:559-305-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA825733163WD1100X, 163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal