Healthcare Provider Details

I. General information

NPI: 1396942496
Provider Name (Legal Business Name): THUY NHU HO-ELLSWORTH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THUY NHU HO DPM

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

IV. Provider business mailing address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4015
  • Fax: 512-901-3935
Mailing address:
  • Phone: 512-901-4015
  • Fax: 512-901-3935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number41000215A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: