Healthcare Provider Details

I. General information

NPI: 1720457997
Provider Name (Legal Business Name): KIM THIEN NGUYEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N ELM ST
GREENSBORO NC
27401-1005
US

IV. Provider business mailing address

4440 HUNTER OAKS CT
HIGH POINT NC
27265-8501
US

V. Phone/Fax

Practice location:
  • Phone: 336-544-5400
  • Fax:
Mailing address:
  • Phone: 336-772-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237302
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5007987
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: