Provider Demographics
NPI:1477984078
Name:PREGONT, NINA (DN)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:PREGONT
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LA CANADA PL
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-9696
Mailing Address - Country:US
Mailing Address - Phone:224-333-6501
Mailing Address - Fax:
Practice Address - Street 1:9 LA CANADA PL
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047
Practice Address - Country:US
Practice Address - Phone:224-333-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181.000382172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath