Provider Demographics
NPI:1679557540
Name:WEBB, MARILYN-LU (NP-BC, PHD, CCCN,)
Entity Type:Individual
Prefix:DR
First Name:MARILYN-LU
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:NP-BC, PHD, CCCN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 MOODY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7553
Mailing Address - Country:US
Mailing Address - Phone:559-299-6592
Mailing Address - Fax:559-299-6592
Practice Address - Street 1:2763 E SHAW AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8220
Practice Address - Country:US
Practice Address - Phone:559-294-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN373569363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098160Medicaid
CAP00084289OtherRAILROAD MEDICARE
CAP00084289OtherRAILROAD MEDICARE
CAGR0098160Medicaid