Healthcare Provider Details

I. General information

NPI: 1295238723
Provider Name (Legal Business Name): THUY THU-THI NGUYEN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # 6033
AUGUSTA GA
30912-1067
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400
AUGUSTA GA
30901-2603
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2331
  • Fax:
Mailing address:
  • Phone: 706-724-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN236467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: