Provider Demographics
NPI:1215591417
Name:NGUYEN, PHUONG K (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:MRS
First Name:PHUONG
Middle Name:K
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 W. PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3204
Mailing Address - Country:US
Mailing Address - Phone:773-761-0011
Mailing Address - Fax:713-761-0008
Practice Address - Street 1:2424 W. PETERSON
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659
Practice Address - Country:US
Practice Address - Phone:773-761-0300
Practice Address - Fax:773-761-0008
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily