MEDICARE: MRS. KRISTINA M NGUYEN MPAS, 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
1	363A00000X	Physician Assistant	PA1258	NV

General Provider Information

NPI Number	:	1669770020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA M NGUYEN MPAS, PA-C

Provider Business Mailing Address
First Line	:	239 JORDAN BRYCE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-5225
Country	:	US
Telephone Number	:	702-461-7958
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 S JONES BLVD
Second Line	:	104
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-7125
Country	:	US
Telephone Number	:	702-880-4193
Fax Number	:	702-880-4197

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

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	06/29/2012

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