Individual provider · Type 1 NPI
Marietta Formoso Light, NP-C
Obstetrics & Gynecology Nurse Practitioner · Clovis, CA
NPI number
1750368650
Active
Practice location
782 Medical Center Dr E Ste 212
Clovis, CA 93611-6889
Fax (559) 451-3680
Mailing address
2625 E Divisadero St
Fresno, CA 93721-1431
Other practice locations
- 782 Medical Center Dr E # 212, Clovis, CA 93611-6889 · (559) 451-3676
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 6030 (CA) |
| Women's Health Nurse Practitioner | 363LW0102X | 6030 (CA) |
| Obstetrics & Gynecology Nurse Practitioner Primary | 363LX0001X | 6030 (CA) |
Obstetrics & Gynecology Nurse Practitioner: Definition to come...
3 other providers at this address
Other obstetrics & gynecology nurse practitioner providers in Clovis
About NPI 1750368650
Marietta Formoso Light, NP-C's National Provider Identifier is 1750368650, issued on Dec 30, 2005. The primary taxonomy on file is Obstetrics & Gynecology Nurse Practitioner (363LX0001X), and the practice location is in Clovis, CA. The record was last updated on Oct 8, 2020.