Provider Demographics
NPI:1760021380
Name:CHESTER, KAWANA IDALI (FNP)
Entity Type:Individual
Prefix:
First Name:KAWANA
Middle Name:IDALI
Last Name:CHESTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAWANA
Other - Middle Name:IDALI
Other - Last Name:CHESTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1422 N ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-8208
Mailing Address - Country:US
Mailing Address - Phone:559-916-2307
Mailing Address - Fax:
Practice Address - Street 1:5765 N FRESNO ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6092
Practice Address - Country:US
Practice Address - Phone:559-389-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF10191200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine