Healthcare Provider Details

I. General information

NPI: 1598578254
Provider Name (Legal Business Name): TRIET DINH NGUYEN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 ANTELOPE BLVD
RED BLUFF CA
96080-2465
US

IV. Provider business mailing address

1968 DELLWOOD DR
REDDING CA
96003-9318
US

V. Phone/Fax

Practice location:
  • Phone: 530-528-7650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: