Provider Demographics
NPI:1558530832
Name:HUYNH, NGUYEN-LY VO (PA-C)
Entity Type:Individual
Prefix:
First Name:NGUYEN-LY
Middle Name:VO
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NGUYEN-LY
Other - Middle Name:THI
Other - Last Name:VO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1275 NW 128TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325
Mailing Address - Country:US
Mailing Address - Phone:515-224-3948
Mailing Address - Fax:515-224-2944
Practice Address - Street 1:1275 NW 128TH ST
Practice Address - Street 2:STE 200
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325
Practice Address - Country:US
Practice Address - Phone:734-502-6716
Practice Address - Fax:515-358-9650
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001868363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical