Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Mateo Licup Nam, NP

Individual provider Registered Nurse · NPI 1538827985

Nicole Mateo Licup Nam, NP is a Registered Nurse in Los Angeles, California. Licensed in California. Registered with an NPI since 2021.

Licensed in
CA
In the registry since
2021
Specialties on file
2
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

11301 Wilshire Blvd # 117
Los Angeles, CA 90073-1003
Phone: (562) 261-7638
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence 95015421 (CA)
Registered Nurse Taxonomy 163W00000X · Licence 95085049 (CA)

Record details

NPI number1538827985
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorNo
NPI enumeratedDecember 2, 2021
Last updated in NPPESFebruary 8, 2022
Certification dateJanuary 29, 2022

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