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General NPI Number Information
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NPI Number | 1609062132
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Entity Type | Organization
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Legal Business Name | AIRELL L NYGAARD MD INC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 680 GUZZI LN SUITE 102
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City | SONORA
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State | CA
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Zip | 95370-5288
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Country | US
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Telephone | 209-588-1800
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Fax | 209-588-1700
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Provider Business Mailing Address
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Address Line | 680 GUZZI LN SUITE 102
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City | SONORA
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State | CA
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Zip | 95370-5288
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Country | US
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Telephone | 209-588-1800
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Fax | 209-588-1700
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Authorized Official
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Title or Position | PRESIDENT & SOLE OWNER
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Name | DR. AIRELL L NYGAARD
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Credential | MD
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Telephone | 209-588-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18044
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License Number State | CA
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