Provider Demographics
NPI:1376902718
Name:NGUYEN, ANH (NP-C)
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:18844 PARK GROVE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-3974
Mailing Address - Country:US
Mailing Address - Phone:214-709-2968
Mailing Address - Fax:
Practice Address - Street 1:18844 PARK GROVE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-3974
Practice Address - Country:US
Practice Address - Phone:214-709-2968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-13
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX781105163W00000X
TXAP131188363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse