Provider Demographics
NPI:1851988802
Name:THAI, VIVIEN (RN)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:
Last Name:THAI
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 1:3359 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5102
Mailing Address - Country:US
Mailing Address - Phone:559-536-2112
Mailing Address - Fax:
Practice Address - Street 1:3359 BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5102
Practice Address - Country:US
Practice Address - Phone:559-536-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565560163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA8132015OtherDRIVER LICENSE