Provider Demographics
NPI:1790526648
Name:RANI, MAMTA (BSN RN)
Entity type:Individual
Prefix:
First Name:MAMTA
Middle Name:
Last Name:RANI
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6837 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1451
Mailing Address - Country:US
Mailing Address - Phone:559-389-3971
Mailing Address - Fax:
Practice Address - Street 1:6837 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1451
Practice Address - Country:US
Practice Address - Phone:559-389-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751584163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management