Healthcare Provider Details

I. General information

NPI: 1104338367
Provider Name (Legal Business Name): CHAU NGUYEN HERRING APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE SAINT LUKES BLVD STE 200
LEES SUMMIT MO
64086-6011
US

IV. Provider business mailing address

608 NW TIMBER RIDGE TRL
LEES SUMMIT MO
64081-2078
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-4302
  • Fax:
Mailing address:
  • Phone: 816-210-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017037522
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: