Provider Demographics
NPI:1104963271
Name:SAWYERS, JEANNETTE ELAINE (RN FNP)
Entity type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:ELAINE
Last Name:SAWYERS
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N GATEWAY BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1622
Mailing Address - Country:US
Mailing Address - Phone:559-251-4800
Mailing Address - Fax:
Practice Address - Street 1:1900 N GATEWAY BLVD # 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1622
Practice Address - Country:US
Practice Address - Phone:559-251-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-03-09
Deactivation Date:2022-01-25
Deactivation Code:
Reactivation Date:2022-03-01
Provider Licenses
StateLicense IDTaxonomies
CA321176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17002ZMedicare ID - Type Unspecified