Provider Demographics
NPI:1932245164
Name:FANUCCHI, JOAN ELIZABETH (BSN, RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ELIZABETH
Last Name:FANUCCHI
Suffix:
Gender:F
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 BLACKROCK DR APT 725
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2218
Mailing Address - Country:US
Mailing Address - Phone:530-666-8645
Mailing Address - Fax:530-666-7447
Practice Address - Street 1:137 NORTH COTTONWOOD STREET
Practice Address - Street 2:SUITE # 2450
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-666-8645
Practice Address - Fax:530-666-7447
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA684984163WC0400X, 163WC1500X, 163WI0600X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0400XNursing Service ProvidersRegistered NurseCase Management
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WI0600XNursing Service ProvidersRegistered NurseInfection Control
Not Answered163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn