Healthcare Provider Details

I. General information

NPI: 1346042975
Provider Name (Legal Business Name): TRANG THI THU NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 MEDINA RD STE 104
MEDINA OH
44256-9634
US

IV. Provider business mailing address

784 MEDINA RD STE 104
MEDINA OH
44256-9634
US

V. Phone/Fax

Practice location:
  • Phone: 330-591-9635
  • Fax: 330-591-4150
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037889
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: