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NPI Code Detail

MEDICARE: MRS. CLARISSE VANESSA NGUEHA-NANA

MEDICARE: MRS. CLARISSE VANESSA NGUEHA-NANA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP130813TX
2363LF0000XFamily Nurse PractitionerAP8915AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356894240
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CLARISSE VANESSA NGUEHA-NANA
Provider Business Mailing Address
First Line : PO BOX 1689
Second Line :
City : SAN LUIS
State : AZ
Zip : 85349-1689
Country : US
Telephone Number : 928-722-6098
Fax Number : 928-627-0007
Provider Business Practice Location Address
First Line : 1233 N MAIN ST STE 10
Second Line :
City : SAN LUIS
State : AZ
Zip : 85336-0663
Country : US
Telephone Number : 928-722-6098
Fax Number : 928-627-0007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2016
Last Update Date : 10/21/2021

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Directions to “ MRS. CLARISSE VANESSA NGUEHA-NANA ” Practice Location

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