Healthcare Provider Details

I. General information

NPI: 1043994965
Provider Name (Legal Business Name): LILY NGUYEN PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 CENTER ST
LUDLOW MA
01056-2733
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 413-625-3500
  • Fax: 413-625-3655
Mailing address:
  • Phone: 603-410-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102356
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: