Provider Demographics
NPI:1811583073
Name:NGUYEN, PHUONG THI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 W OLINDA LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2723
Mailing Address - Country:US
Mailing Address - Phone:714-589-6874
Mailing Address - Fax:
Practice Address - Street 1:14501 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-1306
Practice Address - Country:US
Practice Address - Phone:714-799-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily