Healthcare Provider Details

I. General information

NPI: 1508445156
Provider Name (Legal Business Name): VUONG MY NGUYEN NOLTING PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VUONG MY NGUYEN

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

420 DELAWARE ST SE # MMC603
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2321
  • Fax:
Mailing address:
  • Phone: 952-212-3496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14726
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2023-0028
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: