Healthcare Provider Details

I. General information

NPI: 1639022445
Provider Name (Legal Business Name): MILEY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINH NGUYEN

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 MARBLE AVE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

3833 MONTGOMERY BLVD NE APT 534
ALBUQUERQUE NM
87109-1024
US

V. Phone/Fax

Practice location:
  • Phone: 800-690-0934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number60859
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: