Provider Demographics
NPI:1295499366
Name:NGUYEN, PHUONG TRAN NHA (APRN)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:TRAN NHA
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W STATE HIGHWAY 152
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-3902
Mailing Address - Country:US
Mailing Address - Phone:405-376-3340
Mailing Address - Fax:
Practice Address - Street 1:106 W STATE HIGHWAY 152
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-3902
Practice Address - Country:US
Practice Address - Phone:405-376-3340
Practice Address - Fax:405-737-3606
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily