Healthcare Provider Details

I. General information

NPI: 1750240149
Provider Name (Legal Business Name): PHUONG MAI H NGUYEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAI NGUYEN FNP-C

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 BAINBRIDGE DR
DAPHNE AL
36526-8352
US

IV. Provider business mailing address

8900 BAINBRIDGE DR
DAPHNE AL
36526-8352
US

V. Phone/Fax

Practice location:
  • Phone: 228-238-3670
  • Fax:
Mailing address:
  • Phone: 228-238-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908202
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-162308
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: