Healthcare Provider Details

I. General information

NPI: 1104232131
Provider Name (Legal Business Name): XUAN-AN NGUYEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 8TH ST
STORY CITY IA
50248-1301
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5469
US

V. Phone/Fax

Practice location:
  • Phone: 515-733-5191
  • Fax: 515-733-5354
Mailing address:
  • Phone: 515-239-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-04831
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: