Provider Demographics
NPI:1255545786
Name:NGUYEN, TUYEN M (MD)
Entity type:Individual
Prefix:
First Name:TUYEN
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 80TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3427
Mailing Address - Country:US
Mailing Address - Phone:360-659-1231
Mailing Address - Fax:360-659-7267
Practice Address - Street 1:4404 80TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3427
Practice Address - Country:US
Practice Address - Phone:360-659-1231
Practice Address - Fax:360-659-7267
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NETEP5595207Q00000X
CAPA15763363A00000X
WAMD60135278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055301100Medicaid
NE47055301100Medicaid