Provider Demographics
NPI:1669805511
Name:NGUYEN, QUYNH
Entity type:Individual
Prefix:
First Name:QUYNH
Middle Name:
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 1:3465 W WALNUT ST
Mailing Address - Street 2:225
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7153
Mailing Address - Country:US
Mailing Address - Phone:972-272-7816
Mailing Address - Fax:972-276-8137
Practice Address - Street 1:3465 W WALNUT ST
Practice Address - Street 2:225
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7153
Practice Address - Country:US
Practice Address - Phone:972-272-7816
Practice Address - Fax:972-276-8137
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08460363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant