Provider Demographics
NPI:1437405248
Name:NGUYEN, ROSA PHUONGCHI (FNP)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:PHUONGCHI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BUSINESS PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7449
Mailing Address - Country:US
Mailing Address - Phone:417-336-0033
Mailing Address - Fax:855-710-6552
Practice Address - Street 1:1230 E KINGSLEY ST STE A&B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7211
Practice Address - Country:US
Practice Address - Phone:417-336-0033
Practice Address - Fax:855-710-6552
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1437405248Medicaid
MO1437405248Medicaid
MOP01091569OtherRR MCR
MO132680341Medicare PIN
MO431560263OtherTRICARE