Healthcare Provider Details

I. General information

NPI: 1639018476
Provider Name (Legal Business Name): MONIQUE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MALT DR APT 1402
LONG ISLAND CITY NY
11101-6995
US

IV. Provider business mailing address

220 MALT DR APT 1402
LONG ISLAND CITY NY
11101-6995
US

V. Phone/Fax

Practice location:
  • Phone: 720-209-4003
  • Fax:
Mailing address:
  • Phone: 720-209-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421972
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1667001
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95376074
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberN20539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: