Provider Demographics
NPI:1942602594
Name:MARGOSIAN, JEANELLE T (NP)
Entity Type:Individual
Prefix:MRS
First Name:JEANELLE
Middle Name:T
Last Name:MARGOSIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:1048 N EL CAJON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8617
Mailing Address - Country:US
Mailing Address - Phone:559-281-5644
Mailing Address - Fax:559-439-3936
Practice Address - Street 1:6215 N FRESNO ST STE 108
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5267
Practice Address - Country:US
Practice Address - Phone:559-439-1835
Practice Address - Fax:559-439-3936
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA458940363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology