Provider Demographics
NPI:1851145346
Name:NGUYEN DE CASTRO, LINH LE MAI (DNP, ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:LE MAI
Last Name:NGUYEN DE CASTRO
Suffix:
Gender:F
Credentials:DNP, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:LINH
Other - Middle Name:LE MAI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:752 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3306
Mailing Address - Country:US
Mailing Address - Phone:651-447-7071
Mailing Address - Fax:
Practice Address - Street 1:752 GRAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3306
Practice Address - Country:US
Practice Address - Phone:651-447-7071
Practice Address - Fax:651-478-6920
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2482966163W00000X
IA160483163W00000X
MN11514363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse