Provider Demographics
NPI:1508683814
Name:NOGUES, JADYN CHRISTINE
Entity type:Individual
Prefix:
First Name:JADYN
Middle Name:CHRISTINE
Last Name:NOGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 NW 177TH TER
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6932
Mailing Address - Country:US
Mailing Address - Phone:702-577-7980
Mailing Address - Fax:
Practice Address - Street 1:616 POINT RIDGE PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8810
Practice Address - Country:US
Practice Address - Phone:702-577-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program