Provider Demographics
NPI:1578762902
Name:ZEPEDA, CAROLYN NGUYEN (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:NGUYEN
Last Name:ZEPEDA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:TRAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2025 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2115
Mailing Address - Country:US
Mailing Address - Phone:916-973-4974
Mailing Address - Fax:916-973-7043
Practice Address - Street 1:2025 MORSE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-4974
Practice Address - Fax:916-973-7043
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR157788363LA2200X
CA18470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health