Healthcare Provider Details

I. General information

NPI: 1295315497
Provider Name (Legal Business Name): EMILY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12407 N MOPAC EXPY
AUSTIN TX
78758-2475
US

IV. Provider business mailing address

12407 N MOPAC EXPY
AUSTIN TX
78758-2475
US

V. Phone/Fax

Practice location:
  • Phone: 512-339-6644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: