Basic Information
| Provider Information | |||||||||
| NPI: | 1881685949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLOUNCH-MIYAKAWA | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP/PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 431 S CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932772702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592857678 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1646 S COURT ST | ||||||||
| Address2: | BAART | ||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596258890 | ||||||||
| FaxNumber: | 5597335053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 07/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP5864 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.