Provider Demographics
NPI:1457704371
Name:NGUYEN, MARILYN ANN
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 HURON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3090
Mailing Address - Country:US
Mailing Address - Phone:303-450-7435
Mailing Address - Fax:303-450-7463
Practice Address - Street 1:11310 HURON ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3090
Practice Address - Country:US
Practice Address - Phone:303-450-7435
Practice Address - Fax:303-450-7463
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0062234207Q00000X
MI5101022842390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine