Provider Demographics
NPI:1497529549
Name:NGUYEN, JULIA THANH (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6268
Mailing Address - Country:US
Mailing Address - Phone:860-482-8578
Mailing Address - Fax:
Practice Address - Street 1:780 LITCHFIELD ST STE 200
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6268
Practice Address - Country:US
Practice Address - Phone:860-482-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6357363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant