Provider Demographics
NPI:1861200735
Name:XIONG, TONY (LVN)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:XIONG
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N HUMBOLDT AVE APT 142
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-3542
Mailing Address - Country:US
Mailing Address - Phone:530-592-6926
Mailing Address - Fax:
Practice Address - Street 1:3037 BRYANT PL
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-1613
Practice Address - Country:US
Practice Address - Phone:818-234-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA702623164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse