Healthcare Provider Details

I. General information

NPI: 1114922895
Provider Name (Legal Business Name): MARIA NGUYEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 SW 89TH ST
OKLAHOMA CITY OK
73159-7900
US

IV. Provider business mailing address

12205 SHERRIE ELAINE DR
OKLAHOMA CITY OK
73170-1018
US

V. Phone/Fax

Practice location:
  • Phone: 405-692-3700
  • Fax:
Mailing address:
  • Phone: 316-619-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2286
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: