Healthcare Provider Details

I. General information

NPI: 1447872452
Provider Name (Legal Business Name): AGNES EMILIE NYECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MAIN ST
TURLOCK CA
95380-5107
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-5388
  • Fax: 209-668-5378
Mailing address:
  • Phone: 209-384-6481
  • Fax: 209-359-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA191929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: