Provider Demographics
NPI:1144509175
Name:NGUYEN, THUY
Entity type:Individual
Prefix:
First Name:THUY
Middle Name:
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 1:436 GARDERE AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-4434
Mailing Address - Country:US
Mailing Address - Phone:504-605-5850
Mailing Address - Fax:
Practice Address - Street 1:5421 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4152
Practice Address - Country:US
Practice Address - Phone:504-348-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67641223G0001X
MSP110906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No183500000XPharmacy Service ProvidersPharmacist