Healthcare Provider Details

I. General information

NPI: 1841782117
Provider Name (Legal Business Name): RONA NICCA PINPIN LAM CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RONA NICCA ABADILLA PINPIN

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 04/09/2021
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 7TH AVE
FORT WORTH TX
76104-2733
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-4000
  • Fax:
Mailing address:
  • Phone: 682-885-1860
  • Fax: 680-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP137622
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number797532
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: