Provider Demographics
NPI:1144799826
Name:NGUYEN, LONG HUU (NP-C)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:HUU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12909 BAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1189
Mailing Address - Country:US
Mailing Address - Phone:240-760-9762
Mailing Address - Fax:
Practice Address - Street 1:12909 BAY HILL DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1189
Practice Address - Country:US
Practice Address - Phone:240-760-9762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210239363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner