Provider Demographics
NPI:1639487960
Name:NIMNUAN, ARISA (RN)
Entity Type:Individual
Prefix:
First Name:ARISA
Middle Name:
Last Name:NIMNUAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9972 66TH RD
Mailing Address - Street 2:APT-5E
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4460
Mailing Address - Country:US
Mailing Address - Phone:718-671-2100
Mailing Address - Fax:
Practice Address - Street 1:9972 66TH RD
Practice Address - Street 2:APT-5E
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4460
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY597145163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse