Provider Demographics
NPI:1073251310
Name:NGUYEN, SUSAN ANHXUAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANHXUAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16225 KENWORTH CT
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8485
Mailing Address - Country:US
Mailing Address - Phone:952-212-0242
Mailing Address - Fax:
Practice Address - Street 1:16225 KENWORTH CT
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8485
Practice Address - Country:US
Practice Address - Phone:952-212-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist