Basic Information
| Provider Information | |||||||||
| NPI: | 1124654454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | FNP, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 239 W HUNTINGTON DR | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156920190 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 289 W HUNTINGTON DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910073490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099822719 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2020 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN834267 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 95014236 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.