Healthcare Provider Details

I. General information

NPI: 1093186892
Provider Name (Legal Business Name): NHATMINH NGUYEN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 W TEFFT ST
NIPOMO CA
93444
US

IV. Provider business mailing address

1400 E. CHURCH STREET ATTENTION- MEDICAL STAFF OFFICE
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-2272
  • Fax:
Mailing address:
  • Phone: 805-739-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: