Provider Demographics
NPI:1265896724
Name:NGUYEN, KIM THIEN (RN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:THIEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 MOUNT HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9060
Mailing Address - Country:US
Mailing Address - Phone:503-982-0635
Mailing Address - Fax:503-982-3429
Practice Address - Street 1:1175 MOUNT HOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9060
Practice Address - Country:US
Practice Address - Phone:503-982-0635
Practice Address - Fax:503-982-3429
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-152935163WL0100X
OR201142010RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant