Provider Demographics
NPI:1003220955
Name:NGUYEN, DEBBIE MAI
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:MAI
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 1:12932 SE KENT KANGLEY RD
Mailing Address - Street 2:236
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7940
Mailing Address - Country:US
Mailing Address - Phone:206-734-7199
Mailing Address - Fax:
Practice Address - Street 1:23003 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-7269
Practice Address - Country:US
Practice Address - Phone:206-870-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60290120390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program