Provider Demographics
NPI:1366980906
Name:UNG, NATHALIE (CRNA)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:UNG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 FLICKINGER PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1992
Mailing Address - Country:US
Mailing Address - Phone:408-834-9189
Mailing Address - Fax:
Practice Address - Street 1:1754 FLICKINGER PL
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1992
Practice Address - Country:US
Practice Address - Phone:408-834-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818754163W00000X
CA95000711367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse