Provider Demographics
NPI:1336585488
Name:NGUYEN, MAI LY THI HOLLY (AUD)
Entity Type:Individual
Prefix:DR
First Name:MAI LY
Middle Name:THI HOLLY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:5130 S FORT APACHE RD # 215-430
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1719
Mailing Address - Country:US
Mailing Address - Phone:702-755-9597
Mailing Address - Fax:702-933-8688
Practice Address - Street 1:6767 W TROPICANA AVE STE 212
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4760
Practice Address - Country:US
Practice Address - Phone:702-755-9597
Practice Address - Fax:702-933-8688
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-245237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter