Individual provider · NPI-1

Gina Marie Fenn

Community Health Worker · Clovis, CA

NPI number1104396423
StatusActive
Last updated in NPPESMay 6, 2025

Details

NPI
1104396423
Entity type
Individual (NPI-1)
Name
Gina Marie Fenn
Sex
Female
Sole proprietor
No
Enumeration date
Nov 29, 2018
Certification date
May 6, 2025
Last updated
May 6, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
172V00000X Community Health Worker––Yes

Practice location

90 W Ashlan Ave Ste 100
Clovis, CA 93612-5627

Phone 559-882-5572

Mailing address

1396 W Herndon Ave
Fresno, CA 93711-7126

Phone 559-388-3828

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