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NPI Code Detail

MEDICARE: MS. NANCY NAN NI R.N.

MEDICARE: MS. NANCY NAN NI R.N.
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
1163W00000XRegistered Nurse476908CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1EPS012000OTHERCAPIN FOR EPSDT

General Provider Information

NPI Number : 1528279098
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY NAN NI R.N.
Provider Business Mailing Address
First Line : 3932 GRANDVIEW DR
Second Line :
City : BREA
State : CA
Zip : 92823-1014
Country : US
Telephone Number : 714-524-7689
Fax Number : 714-524-1259
Provider Business Practice Location Address
First Line : 1502 RIDGEMONT CT
Second Line :
City : FULLERTON
State : CA
Zip : 92831-1223
Country : US
Telephone Number : 714-526-1130
Fax Number : 714-526-1351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 07/08/2007

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