Provider Demographics
NPI:1598844417
Name:NGO, VAN KHANH (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:VAN
Middle Name:KHANH
Last Name:NGO
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3387 SE TEAL DR
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8070
Mailing Address - Country:US
Mailing Address - Phone:503-916-9702
Mailing Address - Fax:
Practice Address - Street 1:3387 SE TEAL DR
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-8070
Practice Address - Country:US
Practice Address - Phone:503-916-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213114Medicaid