Provider Demographics
NPI:1346410289
Name:NGUYEN-MAGDAEL, GINA T (NP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:T
Last Name:NGUYEN-MAGDAEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:THUY
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:200 COTTAGE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4935
Mailing Address - Country:US
Mailing Address - Phone:209-624-5800
Mailing Address - Fax:
Practice Address - Street 1:200 COTTAGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4935
Practice Address - Country:US
Practice Address - Phone:209-624-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner