Provider Demographics
NPI:1619479797
Name:NGUYEN, PETERSON HIEN (CRNA)
Entity Type:Individual
Prefix:
First Name:PETERSON
Middle Name:HIEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 FERNGLEN WAY
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3755
Mailing Address - Country:US
Mailing Address - Phone:562-264-9410
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST FL 11
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:667-214-1616
Practice Address - Fax:410-328-1674
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA768650163W00000X
CANA95000925367500000X
MDR217862367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse