Provider Demographics
NPI:1396587077
Name:NGAN, OLIVER BRYAN TAN (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:OLIVER BRYAN
Middle Name:TAN
Last Name:NGAN
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 PAGOLA AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8628
Mailing Address - Country:US
Mailing Address - Phone:559-380-6641
Mailing Address - Fax:209-451-2561
Practice Address - Street 1:2345 NEW BRIGHTON LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4290
Practice Address - Country:US
Practice Address - Phone:559-380-6641
Practice Address - Fax:209-451-2561
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA735801163WG0000X, 163WH1000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH1000XNursing Service ProvidersRegistered NurseHospice