Provider Demographics
NPI:1720600364
Name:THEOLET, AMANDA YVETTE (CLINICAL NURSE LEADE)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:YVETTE
Last Name:THEOLET
Suffix:
Gender:F
Credentials:CLINICAL NURSE LEADE
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:YVETTE
Other - Last Name:HOLGUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1117
Mailing Address - Country:US
Mailing Address - Phone:559-978-6719
Mailing Address - Fax:
Practice Address - Street 1:2615 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2223
Practice Address - Country:US
Practice Address - Phone:559-225-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95210279163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency