Provider Demographics
NPI:1609574573
Name:NGUYEN, NICOLE ASHLEY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ASHLEY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ASHLEY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5442 W CEDAR CREST CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-9603
Mailing Address - Country:US
Mailing Address - Phone:920-209-3693
Mailing Address - Fax:
Practice Address - Street 1:300 N COMMERCIAL ST STE 200
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2619
Practice Address - Country:US
Practice Address - Phone:920-886-0818
Practice Address - Fax:920-886-0773
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13617-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily