MEDICARE: OANH HOANG NGUYEN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	053173339	GA
2	164W00000X	Licensed Practical Nurse	LPN073491	GA
3	3747A0650X	Attendant Care Provider
4	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1386928513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OANH HOANG NGUYEN LPN

Provider Business Mailing Address
First Line	:	740 JACKSON BANK PL NW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-6067
Country	:	US
Telephone Number	:	678-523-0811
Fax Number	:	770-638-4631

Provider Business Practice Location Address
First Line	:	740 JACKSON BANK PL NW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-6067
Country	:	US
Telephone Number	:	678-523-0811
Fax Number	:	770-638-4631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	10/14/2011

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