Provider Demographics
NPI:1205345436
Name:KENNANG, NADINE NGUENA (LVN, RN)
Entity type:Individual
Prefix:MS
First Name:NADINE
Middle Name:NGUENA
Last Name:KENNANG
Suffix:
Gender:F
Credentials:LVN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 213093
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91921-3093
Mailing Address - Country:US
Mailing Address - Phone:888-417-5163
Mailing Address - Fax:
Practice Address - Street 1:400 S KENMORE AVE APT 414
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2436
Practice Address - Country:US
Practice Address - Phone:424-221-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide