Provider Demographics
NPI:1235171703
Name:ACEVES, NANCY (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:ACEVES
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:PHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:420 W ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2943
Mailing Address - Country:US
Mailing Address - Phone:626-331-6411
Mailing Address - Fax:
Practice Address - Street 1:420 W ROWLAND ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2943
Practice Address - Country:US
Practice Address - Phone:626-331-6411
Practice Address - Fax:626-251-1423
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605857163W00000X
CA15694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q77887Medicare UPIN