Provider Demographics
NPI:1992855514
Name:TOWER CLINIC FOR WOMEN AND CHILDREN A NURSE PRACTIONER AND NURSING MID
Entity Type:Organization
Organization Name:TOWER CLINIC FOR WOMEN AND CHILDREN A NURSE PRACTIONER AND NURSING MID
Other - Org Name:TOWER FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ISTVANICK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:559-264-7062
Mailing Address - Street 1:1277 N WISHON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2346
Mailing Address - Country:US
Mailing Address - Phone:559-264-7059
Mailing Address - Fax:559-264-7057
Practice Address - Street 1:1277 N WISHON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2346
Practice Address - Country:US
Practice Address - Phone:559-264-7059
Practice Address - Fax:559-264-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN479392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G692111Medicaid
CAZZZ178947OtherMEDICARE GROUP #
CA00G692111Medicaid
6648237Medicare PIN