Provider Demographics
NPI:1154528313
Name:STATON, MARY YVETTE (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:YVETTE
Last Name:STATON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:YVETTE
Other - Last Name:CUTSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5749 W COUNTRY AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5502
Mailing Address - Country:US
Mailing Address - Phone:559-739-8104
Mailing Address - Fax:
Practice Address - Street 1:5533 W HILLSDALE AVE # 3
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5138
Practice Address - Country:US
Practice Address - Phone:559-622-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily