Individual
MR. BRIAN JAMES NAKKERUD-WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, PMHFNPC
Contact information
Practice address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663
Mailing address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
802020
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
23511
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
87055
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FHC70042F
MEDI-CAL PTAN GROUP#
CA
01
—
FHC70044F
MEDI-CAL PTAN GROUP#
CA
01
—
ZZZ91891Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
—
ZZZ91892Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
—
ZZZ92069Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
Enumeration date
08/21/2012
Last updated
05/11/2017
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