Provider Demographics
NPI:1205459369
Name:NGUYEN, THU THANH (FNP)
Entity type:Individual
Prefix:
First Name:THU
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 QUAIL TRAIL
Mailing Address - Street 2:UNIT B
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015
Mailing Address - Country:US
Mailing Address - Phone:505-208-0204
Mailing Address - Fax:505-717-2884
Practice Address - Street 1:104 QUAIL TRAIL
Practice Address - Street 2:UNIT B
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015
Practice Address - Country:US
Practice Address - Phone:505-208-0204
Practice Address - Fax:505-717-2884
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM59655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily