Healthcare Provider Details

I. General information

NPI: 1609676758
Provider Name (Legal Business Name): VIVIAN VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4168 GUSTON PL
COLUMBUS OH
43230-8479
US

IV. Provider business mailing address

4168 GUSTON PL
COLUMBUS OH
43230-8479
US

V. Phone/Fax

Practice location:
  • Phone: 614-940-0791
  • Fax:
Mailing address:
  • Phone: 614-940-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN.479608
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: