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NPI Code Detail

MEDICARE: MS. PHUONG QUYNH THI NGUYEN PA-C

MEDICARE: MS. PHUONG QUYNH THI NGUYEN PA-C
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
1363A00000XPhysician Assistant0010-12529NC

General Provider Information

NPI Number : 1477200806
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PHUONG QUYNH THI NGUYEN PA-C
Provider Business Mailing Address
First Line : 1907 S 17TH ST STE 1
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-6680
Country : US
Telephone Number : 910-343-8424
Fax Number : 910-343-6989
Provider Business Practice Location Address
First Line : 1907 S 17TH ST STE 1
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-6680
Country : US
Telephone Number : 910-343-8424
Fax Number : 910-343-6989
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2022
Last Update Date : 01/01/2026

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