Basic Information
Provider Information
NPI: 1588223762
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FURRER
FirstName: CHRISTINA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2625 E DIVISADERO ST
Address2:  
City: FRESNO
State: CA
PostalCode: 937211431
CountryCode: US
TelephoneNumber: 5594432682
FaxNumber: 5594432681
Practice Location
Address1: 604 N MAGNOLIA AVE STE 100
Address2:  
City: CLOVIS
State: CA
PostalCode: 936119205
CountryCode: US
TelephoneNumber: 5593200531
FaxNumber: 5593200539
Other Information
ProviderEnumerationDate: 06/11/2019
LastUpdateDate: 11/04/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  N Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363AS0400X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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