Provider Demographics
NPI:1922865211
Name:NGUYEN, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
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 1:3120 FAIRVIEW PARK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4570
Mailing Address - Country:US
Mailing Address - Phone:571-899-0476
Mailing Address - Fax:
Practice Address - Street 1:3120 FAIRVIEW PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4570
Practice Address - Country:US
Practice Address - Phone:571-899-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other