Provider Demographics
NPI:1790450971
Name:NGUYEN, TINA (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 FRONT ST S STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-9415
Mailing Address - Country:US
Mailing Address - Phone:253-655-0645
Mailing Address - Fax:
Practice Address - Street 1:9500 FRONT ST S STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-9415
Practice Address - Country:US
Practice Address - Phone:253-655-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60756280163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)