Provider Demographics
NPI:1760750079
Name:NGUYEN, TAMMY M
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:M
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 1:1222 BODEGA DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-0825
Mailing Address - Country:US
Mailing Address - Phone:702-234-4521
Mailing Address - Fax:
Practice Address - Street 1:480 GALLETTI WAY BLDG 8C
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5564
Practice Address - Country:US
Practice Address - Phone:775-324-1490
Practice Address - Fax:775-324-1541
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner