Provider Demographics
NPI:1063560290
Name:PIMPHAN, NALINEE (RN, FNP)
Entity type:Individual
Prefix:MRS
First Name:NALINEE
Middle Name:
Last Name:PIMPHAN
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:MRS
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:PIMPHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:3649 W BEECHWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0693
Mailing Address - Country:US
Mailing Address - Phone:559-439-1534
Mailing Address - Fax:559-439-1083
Practice Address - Street 1:3649 W BEECHWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0693
Practice Address - Country:US
Practice Address - Phone:559-439-1534
Practice Address - Fax:559-439-1083
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12678363LP0808X
CA522582163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ5065ZMedicare ID - Type Unspecified