Healthcare Provider Details

I. General information

NPI: 1659910693
Provider Name (Legal Business Name): STEPHANIE THANH NGUYEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2019
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 S QUEEN ST
DOVER DE
19904-3568
US

IV. Provider business mailing address

3002 SPRUCE CT
DOVER DE
19901-7922
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-9310
  • Fax: 302-744-9312
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011470
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: