Provider Demographics
NPI:1801149422
Name:NGUYEN, TAM TRYAN (LPN)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:TRYAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4882
Mailing Address - Country:US
Mailing Address - Phone:714-675-2004
Mailing Address - Fax:
Practice Address - Street 1:360 HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4882
Practice Address - Country:US
Practice Address - Phone:714-675-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148994164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH148994OtherOHIO BOARD OF NURSING