Provider Demographics
NPI:1922167857
Name:GO, NELLIE VERZOSA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NELLIE
Middle Name:VERZOSA
Last Name:GO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 R ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1312
Mailing Address - Country:US
Mailing Address - Phone:559-233-3131
Mailing Address - Fax:559-233-3133
Practice Address - Street 1:1053 R ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1312
Practice Address - Country:US
Practice Address - Phone:559-233-3131
Practice Address - Fax:559-233-3133
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP10795OtherN.P LICENSE
CAS92081Medicare UPIN
CAZZZ17302ZMedicare ID - Type Unspecified