Healthcare Provider Details

I. General information

NPI: 1164909701
Provider Name (Legal Business Name): REBECCA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7157 E SAGINAW ST
EAST LANSING MI
48823-9627
US

IV. Provider business mailing address

2340 CLUB MERIDIAN DR APT A5
OKEMOS MI
48864-4553
US

V. Phone/Fax

Practice location:
  • Phone: 517-885-9010
  • Fax: 517-885-9065
Mailing address:
  • Phone: 419-309-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302046440
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: