Provider Demographics
NPI:1881685949
Name:CLOUNCH-MIYAKAWA, JUDY ELLEN (FNP/PA)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ELLEN
Last Name:CLOUNCH-MIYAKAWA
Suffix:
Gender:F
Credentials:FNP/PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2702
Mailing Address - Country:US
Mailing Address - Phone:559-285-7678
Mailing Address - Fax:
Practice Address - Street 1:1646 S COURT ST
Practice Address - Street 2:BAART
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-625-8890
Practice Address - Fax:559-733-5053
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP5864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ00805Medicare UPIN
CAZZZ39955ZMedicare ID - Type Unspecified