Provider Demographics
NPI:1639280886
Name:FESSEL, MARY JUNE (RNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JUNE
Last Name:FESSEL
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:FESSEL
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:520 COTTONWOOD ST
Practice Address - Street 2:SUITE 10
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3603
Practice Address - Country:US
Practice Address - Phone:530-662-4646
Practice Address - Fax:530-664-4235
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 5945363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health