Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Nisebho Kefelegn Fantaye, PA-C

Individual provider Physician Assistant · NPI 1942875778

Nisebho Kefelegn Fantaye, PA-C is a Physician Assistant in Marysville, California. Practices as a sole proprietor and works from 2 locations. Licensed in California.

Licensed in
CA
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

726 4th St
Marysville, CA 95901-5656
Phone: (530) 749-4300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1310 Club Dr, Vallejo, CA 94592-1187 — (408) 509-0856

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 62852 (CA)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1942875778
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedMay 24, 2021
Last updated in NPPESSeptember 5, 2023
Certification dateSeptember 5, 2023

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