Provider Demographics
NPI:1245764513
Name:NAHAL, SUMON (LVN)
Entity Type:Individual
Prefix:
First Name:SUMON
Middle Name:
Last Name:NAHAL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4519
Mailing Address - Country:US
Mailing Address - Phone:209-383-5200
Mailing Address - Fax:
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1324
Practice Address - Country:US
Practice Address - Phone:209-243-9277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 275290164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse