Provider Demographics
NPI:1982297719
Name:VO, MINH VAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:VAN
Last Name:VO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7884 SEWARD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8637
Mailing Address - Country:US
Mailing Address - Phone:151-390-7108
Mailing Address - Fax:
Practice Address - Street 1:7884 SEWARD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45011-8637
Practice Address - Country:US
Practice Address - Phone:151-390-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00034987103TP0016X
313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care FacilityGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06080816Medicaid