Provider Demographics
NPI:1811336191
Name:PRYOR, NANCY ANNETTE (COTA)
Entity type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:ANNETTE
Last Name:PRYOR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11354
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93772-1354
Mailing Address - Country:US
Mailing Address - Phone:559-977-0257
Mailing Address - Fax:
Practice Address - Street 1:575 E ALLUVIAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2822
Practice Address - Country:US
Practice Address - Phone:559-224-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 1065172V00000X
CANBCOT 1038550172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker