Healthcare Provider Details

I. General information

NPI: 1770837106
Provider Name (Legal Business Name): GANTUYA NADMIDTSEREN PAGE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S ST
EUREKA CA
95501-3139
US

IV. Provider business mailing address

2020 S ST
EUREKA CA
95501-3139
US

V. Phone/Fax

Practice location:
  • Phone: 707-497-9909
  • Fax:
Mailing address:
  • Phone: 707-497-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95040610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: