Provider Demographics
NPI:1477630036
Name:NGUYEN, ANNE QUYEN
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:QUYEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10203 WINECREEK CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3728
Mailing Address - Country:US
Mailing Address - Phone:714-470-0621
Mailing Address - Fax:
Practice Address - Street 1:10203 WINECREEK CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3728
Practice Address - Country:US
Practice Address - Phone:714-470-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 11007363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMN0558190OtherDEA NUMBER
CAS85917Medicare UPIN