Healthcare Provider Details

I. General information

NPI: 1972277747
Provider Name (Legal Business Name): HA HOANG NHAT NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMMER NGUYEN PA-C

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 PIONEER WOODS DR
LINCOLN NE
68506-7548
US

IV. Provider business mailing address

5032 W STAMPEDE LN
LINCOLN NE
68528-2220
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-4900
  • Fax: 402-484-6456
Mailing address:
  • Phone: 402-805-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2633
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: