Healthcare Provider Details

I. General information

NPI: 1518323856
Provider Name (Legal Business Name): NHU THUY LUONG P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15809 NE 23RD ST
CHOCTAW OK
73020-8428
US

IV. Provider business mailing address

28 CORONA DR
OKLAHOMA CITY OK
73149-1806
US

V. Phone/Fax

Practice location:
  • Phone: 405-390-9600
  • Fax: 405-390-9400
Mailing address:
  • Phone: 405-628-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2579
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: