Healthcare Provider Details

I. General information

NPI: 1225877632
Provider Name (Legal Business Name): PHUC HA PHUONG NGUYEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 TURNPIKE ST STE 33
CANTON MA
02021-2856
US

IV. Provider business mailing address

1017 TURNPIKE ST STE 33
CANTON MA
02021-2856
US

V. Phone/Fax

Practice location:
  • Phone: 781-236-7343
  • Fax: 781-806-1026
Mailing address:
  • Phone: 781-236-7343
  • Fax: 781-806-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2326473
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: