MEDICARE: YENKHA NGUYEN ARZOLA RN

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	163W00000X	Registered Nurse	939483	TX

General Provider Information

NPI Number	:	1932678208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YENKHA NGUYEN ARZOLA RN

Provider Business Mailing Address
First Line	:	290 W LAKE PARK RD APT 804
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-3886
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 W LAKE PARK RD APT 804
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-3886
Country	:	US
Telephone Number	:	469-933-8266
Fax Number	:

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

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	11/16/2018

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