Provider Demographics
NPI:1568164366
Name:NGUYEN, DEBBIE VY KHANH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBBIE VY
Middle Name:KHANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:KHANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:200 PORTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1524
Mailing Address - Country:US
Mailing Address - Phone:925-838-2108
Mailing Address - Fax:
Practice Address - Street 1:200 PORTER DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1524
Practice Address - Country:US
Practice Address - Phone:925-838-2108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily