Healthcare Provider Details

I. General information

NPI: 1669122685
Provider Name (Legal Business Name): MICHELLE NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E PRATER WAY
SPARKS NV
89434-9641
US

IV. Provider business mailing address

732 S 6TH ST STE R
LAS VEGAS NV
89101-6948
US

V. Phone/Fax

Practice location:
  • Phone: 775-331-7000
  • Fax:
Mailing address:
  • Phone: 850-972-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29358
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: