Healthcare Provider Details

I. General information

NPI: 1114617842
Provider Name (Legal Business Name): ANNA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE FL 3
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

9610 MIDSOMER PL
SAN ANTONIO TX
78255-2467
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: