Healthcare Provider Details

I. General information

NPI: 1891033601
Provider Name (Legal Business Name): ANH PHOA ANH NGUYEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MDG UNIT 5071
APO AP
96328-5071
US

IV. Provider business mailing address

374 MDG UNIT 5071
APO AP
96328-5071
US

V. Phone/Fax

Practice location:
  • Phone: 315-225-7508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13210371-8906
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: