Provider Demographics
NPI:1336737360
Name:NGUYEN, VANVAN BAOHA (PA-C)
Entity Type:Individual
Prefix:
First Name:VANVAN
Middle Name:BAOHA
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 DOLLAR CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5726
Mailing Address - Country:US
Mailing Address - Phone:702-576-2479
Mailing Address - Fax:
Practice Address - Street 1:3175 SAINT ROSE PKWY STE 121
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3507
Practice Address - Country:US
Practice Address - Phone:702-802-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical