Provider Demographics
NPI:1528448362
Name:NIMNUAN, CHAMNONG (LPN)
Entity type:Individual
Prefix:
First Name:CHAMNONG
Middle Name:
Last Name:NIMNUAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9972 66TH RD
Mailing Address - Street 2:APT 5E
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4460
Mailing Address - Country:US
Mailing Address - Phone:646-500-4255
Mailing Address - Fax:
Practice Address - Street 1:9972 66TH RD
Practice Address - Street 2:APT 5E
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4460
Practice Address - Country:US
Practice Address - Phone:646-500-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2966331164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse