Provider Demographics
NPI:1124101563
Name:TAUSHECK, CAM LAN BUI (FNP)
Entity type:Individual
Prefix:
First Name:CAM LAN
Middle Name:BUI
Last Name:TAUSHECK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAM LAN
Other - Middle Name:THI
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:5655 VERNER OAK CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2039
Mailing Address - Country:US
Mailing Address - Phone:916-425-8894
Mailing Address - Fax:
Practice Address - Street 1:4055 VALLEY VIEW LN STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244
Practice Address - Country:US
Practice Address - Phone:972-715-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF11829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP54000Medicare UPIN