| Doctor Name: | NI KETUT SUPIYATI |
| NPI Number: | 1023497443 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | NP95001498 |
| Business Practice Address: | 2638 E Florence Ave Huntington Park, CA - 902554708 |
| Business Phone Number: | 3235814665 |
| Business Fax Number: | 3235810551 |
| Mailing Address: | 2638 E Florence Ave, HUNTINGTON PARK |
| State: | CA |
| Postal Code: | 902554708 |
| Phone Number: | 3235814665 |
| Fax Number: | 3235810551 |
| NPI Enumeration Date: | 05/19/2015 |
| NPI Last Update Date: | 05/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363L00000X |
| License Number: | NP95001498 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |