Provider Demographics
NPI:1154655256
Name:NGUYEN, THERESA HT (ABOC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:HT
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 SUMMIT BRIDGE RD.
Mailing Address - Street 2:UNIT #7
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709
Mailing Address - Country:US
Mailing Address - Phone:302-464-1069
Mailing Address - Fax:888-464-1099
Practice Address - Street 1:4446 SUMMIT BRIDGE RD.
Practice Address - Street 2:UNIT #7
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709
Practice Address - Country:US
Practice Address - Phone:302-464-1069
Practice Address - Fax:888-464-1099
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2009603551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist