Provider Demographics
NPI:1336768522
Name:CHRISTOFFERSEN, MAYRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:CHRISTOFFERSEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:
Other - Last Name:NEGRETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3812 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4301
Mailing Address - Country:US
Mailing Address - Phone:559-495-3120
Mailing Address - Fax:
Practice Address - Street 1:3812 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4301
Practice Address - Country:US
Practice Address - Phone:559-495-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily