Healthcare Provider Details

I. General information

NPI: 1639931934
Provider Name (Legal Business Name): KATRINA TRAM NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2598 WINDMILL PKWY STE 110
HENDERSON NV
89074-5476
US

IV. Provider business mailing address

1552 W WARM SPRINGS RD STE 100
HENDERSON NV
89014-4328
US

V. Phone/Fax

Practice location:
  • Phone: 702-933-5544
  • Fax:
Mailing address:
  • Phone: 702-933-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number839824
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: