Healthcare Provider Details

I. General information

NPI: 1588297154
Provider Name (Legal Business Name): VALERIE-THAO-NHU NGUYEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32255 NORTHWESTERN HWY STE 100
FARMINGTON HILLS MI
48334-1573
US

IV. Provider business mailing address

32255 NORTHWESTERN HWY STE 100
FARMINGTON HILLS MI
48334-1573
US

V. Phone/Fax

Practice location:
  • Phone: 888-647-1100
  • Fax: 248-419-3544
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: