MEDICARE: MS. CYNTHIA LOUISE NUGENT FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	17350	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17350	OTHER	CA	NURSE PRACTITIONERS LICENSE

General Provider Information

NPI Number	:	1356595524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA LOUISE NUGENT FNP-C

Provider Business Mailing Address
First Line	:	2891 CHURN CREEK RD
Second Line	:	SUITE A
City	:	REDDING
State	:	CA
Zip	:	96002-1148
Country	:	US
Telephone Number	:	530-221-7474
Fax Number	:	530-226-6239

Provider Business Practice Location Address
First Line	:	2891 CHURN CREEK RD
Second Line	:	SUITE A
City	:	REDDING
State	:	CA
Zip	:	96002-1148
Country	:	US
Telephone Number	:	530-221-7474
Fax Number	:	530-226-6239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/13/2008

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