Provider Demographics
NPI:1669046108
Name:NGUYEN, HIEU THI KIM
Entity Type:Individual
Prefix:
First Name:HIEU
Middle Name:THI KIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15115 NE 96TH ST, VANCOUVER
Mailing Address - Street 2:VANCOUVER
Mailing Address - City:WASHINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98682
Mailing Address - Country:US
Mailing Address - Phone:360-718-8783
Mailing Address - Fax:360-718-8783
Practice Address - Street 1:15115 NE 96TH ST
Practice Address - Street 2:VANCOUVER
Practice Address - City:WASHINGTON
Practice Address - State:WA
Practice Address - Zip Code:98682
Practice Address - Country:US
Practice Address - Phone:360-718-8783
Practice Address - Fax:360-718-8783
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60650979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse