Provider Demographics
NPI:1881272698
Name:NGUYEN, THANH THILOAN (NP)
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:THILOAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3795 GOLDLEAF TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-1659
Mailing Address - Country:US
Mailing Address - Phone:832-716-7931
Mailing Address - Fax:
Practice Address - Street 1:3795 GOLDLEAF TRAIL DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-1659
Practice Address - Country:US
Practice Address - Phone:832-716-7931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007374363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology