Provider Demographics
NPI:1053330126
Name:NGUYEN, JENNIFER T (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADVANTAGE
Other - Middle Name:WOMEN'S
Other - Last Name:CARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19740 INTERSTATE 45 N
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2941
Mailing Address - Country:US
Mailing Address - Phone:281-537-5556
Mailing Address - Fax:281-537-5560
Practice Address - Street 1:19740 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2941
Practice Address - Country:US
Practice Address - Phone:281-537-5556
Practice Address - Fax:281-537-5560
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181597901Medicaid
TX181597901Medicaid
TX8F3649Medicare ID - Type Unspecified