Provider Demographics
NPI:1700870318
Name:NGUYEN, NICOLE N
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:N
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 1:12350 WESTHEIMER RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6004
Mailing Address - Country:US
Mailing Address - Phone:281-496-1199
Mailing Address - Fax:
Practice Address - Street 1:12350 WESTHEIMER RD
Practice Address - Street 2:SUITE G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6004
Practice Address - Country:US
Practice Address - Phone:281-496-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10001202OtherTAMG AMERIGROUP GROUP NUM
TX8H1981OtherTAMG BCBS INDIVIDUAL
TX080591301OtherTAMG - GROUP MEDICAID NUM
TX00438NOtherTAMG-BCBS OF TEXAS GROUP#
TX171991601Medicaid
TX00438NOtherTAMG GROUP MEDICARE NUMBE
TX10012256OtherTAMG AMERIGROUP INDIVIDUA
TX10001202OtherTAMG AMERIGROUP GROUP NUM
TX171991601Medicaid