Healthcare Provider Details

I. General information

NPI: 1427430628
Provider Name (Legal Business Name): LAN NGUYEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4679
US

IV. Provider business mailing address

3821 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4679
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-7400
  • Fax: 505-998-7741
Mailing address:
  • Phone: 505-998-7400
  • Fax: 505-998-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02715
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: