Provider Demographics
NPI:1841695723
Name:PANIAGUA, NIKAESHA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:NIKAESHA
Middle Name:
Last Name:PANIAGUA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 BEECH ST.
Mailing Address - Street 2:BLDG 949
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652
Mailing Address - Country:US
Mailing Address - Phone:916-640-0558
Mailing Address - Fax:
Practice Address - Street 1:3401 BEECH ST.
Practice Address - Street 2:BLDG 949
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652
Practice Address - Country:US
Practice Address - Phone:916-640-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA831783163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse