Provider Demographics
NPI:1720619885
Name:NG, PENTE (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:PENTE
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, FNP-C
Mailing Address - Street 1:370 N WIGET LN STE 250
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2454
Mailing Address - Country:US
Mailing Address - Phone:925-945-7005
Mailing Address - Fax:925-236-2784
Practice Address - Street 1:1200 CENTRAL BLVD STE D
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2227
Practice Address - Country:US
Practice Address - Phone:925-308-9510
Practice Address - Fax:925-236-2784
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily