Healthcare Provider Details

I. General information

NPI: 1013847649
Provider Name (Legal Business Name): RAD LIL NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LE RAD LIL NGUYEN

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W LOMBARD ST
BALTIMORE MD
21201-1512
US

IV. Provider business mailing address

1101 HIGGINS PL APT 306
ROCKVILLE MD
20852-6727
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-0501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1091813
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: