Provider Demographics
NPI:1972811438
Name:NGUYEN, THU MINH PHAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:THU
Middle Name:MINH PHAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:125 LIBERTY ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1114
Mailing Address - Country:US
Mailing Address - Phone:413-733-9955
Mailing Address - Fax:413-733-1199
Practice Address - Street 1:125 LIBERTY ST
Practice Address - Street 2:SUITE 403
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1114
Practice Address - Country:US
Practice Address - Phone:413-733-9955
Practice Address - Fax:413-733-1199
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4041363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant