Provider Demographics
NPI:1578006425
Name:HAUG, NICOLETTE JASMIN (NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:JASMIN
Last Name:HAUG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:NICOLETTE
Other - Middle Name:JASMIN
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9436 SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4748
Mailing Address - Country:US
Mailing Address - Phone:562-942-3229
Mailing Address - Fax:
Practice Address - Street 1:9436 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4748
Practice Address - Country:US
Practice Address - Phone:562-942-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-27
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily