MEDICARE: MR. RONGCHAI SODCHUN NILMAG RN, BSN, VA-BC

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
1	163W00000X	Registered Nurse	1655188	CO

General Provider Information

NPI Number	:	1427749779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONGCHAI SODCHUN NILMAG RN, BSN, VA-BC

Provider Business Mailing Address
First Line	:	6031 N ORLEANS ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80019-2221
Country	:	US
Telephone Number	:	832-766-7726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 N CENTRAL EXPY STE 280
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2057
Country	:	US
Telephone Number	:	866-747-7422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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