Healthcare Provider Details

I. General information

NPI: 1912288564
Provider Name (Legal Business Name): LINH MY NGUYEN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S 48TH ST
SPRINGDALE AR
72762-6683
US

IV. Provider business mailing address

1213 ROLLING OAKS LN
ROGERS AR
72756-2332
US

V. Phone/Fax

Practice location:
  • Phone: 479-725-5224
  • Fax:
Mailing address:
  • Phone: 479-685-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR89083
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: