Healthcare Provider Details

I. General information

NPI: 1104434513
Provider Name (Legal Business Name): MISS VINH THI NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/10/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W CHARLESTON BLVD
LAS VEGAS NV
89102-2149
US

IV. Provider business mailing address

2300 W CHARLESTON BLVD
LAS VEGAS NV
89102-2149
US

V. Phone/Fax

Practice location:
  • Phone: 702-724-8787
  • Fax:
Mailing address:
  • Phone: 702-724-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number832734
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number832734
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: