Provider Demographics
NPI:1508168089
Name:AN, JENNIFER NGUYEN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NGUYEN
Last Name:AN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELLEN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:571-261-3529
Mailing Address - Fax:703-361-1811
Practice Address - Street 1:8640 SUDLEY RD STE 303
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:571-261-3529
Practice Address - Fax:703-361-1811
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112123207V00000X
VA0101253542207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology