Provider Demographics
NPI:1083109177
Name:CAO, VAN THUY TUONG
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:THUY TUONG
Last Name:CAO
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 1:3130 VIRGINA ST
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-3646
Mailing Address - Country:US
Mailing Address - Phone:901-674-8844
Mailing Address - Fax:
Practice Address - Street 1:3130 VIRGINA ST
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-3646
Practice Address - Country:US
Practice Address - Phone:901-674-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-30
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX884941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse