Provider Demographics
NPI:1902397045
Name:PHANGRATH, DOUANGCHAY JUDY (FNP)
Entity Type:Individual
Prefix:
First Name:DOUANGCHAY
Middle Name:JUDY
Last Name:PHANGRATH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:PHANGRATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:7197 W SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93723-9397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4361 LATHAM ST STE 270
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4332
Practice Address - Country:US
Practice Address - Phone:559-285-5946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily