Provider Demographics
NPI:1346774320
Name:NGUYEN, JEANNIE MAI (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:MAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD, MS
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:7700 FISH POND RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1031
Practice Address - Country:US
Practice Address - Phone:254-761-4444
Practice Address - Fax:254-761-4441
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3148207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology