Provider Demographics
NPI:1760263636
Name:NGUYEN, KATIE DA THAO (RN, FNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:DA THAO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEACOUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5535
Mailing Address - Country:US
Mailing Address - Phone:949-292-4873
Mailing Address - Fax:
Practice Address - Street 1:1 SEACOUNTRY LN
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-5535
Practice Address - Country:US
Practice Address - Phone:949-292-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily