Healthcare Provider Details

I. General information

NPI: 1437405248
Provider Name (Legal Business Name): ROSA PHUONGCHI NGUYEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 E KINGSLEY ST STE A&B
SPRINGFIELD MO
65804-7211
US

IV. Provider business mailing address

110 BUSINESS PARK DR STE C
BRANSON MO
65616-7449
US

V. Phone/Fax

Practice location:
  • Phone: 417-336-0033
  • Fax: 855-710-6552
Mailing address:
  • Phone: 417-336-0033
  • Fax: 855-710-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012025989
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: