MEDICARE: TRIET DINH NGUYEN 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	95033716	CA

General Provider Information

NPI Number	:	1598578254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRIET DINH NGUYEN FNP-C

Provider Business Mailing Address
First Line	:	1968 DELLWOOD DR
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96003-9318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 ANTELOPE BLVD
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-2465
Country	:	US
Telephone Number	:	530-528-7650
Fax Number	:

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

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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