Healthcare Provider Details

I. General information

NPI: 1942680244
Provider Name (Legal Business Name): NGA TUYET HOANG PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST STE B55
PORTLAND OR
97213-2957
US

IV. Provider business mailing address

5050 NE HOYT ST STE B55
PORTLAND OR
97213-2957
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-5393
  • Fax:
Mailing address:
  • Phone: 503-464-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number201402962RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201707717NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: