Healthcare Provider Details

I. General information

NPI: 1497471221
Provider Name (Legal Business Name): VINH THI THIEU LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W MAIN ST STE 201
LEWISVILLE TX
75057-3604
US

IV. Provider business mailing address

560 W MAIN ST STE 201
LEWISVILLE TX
75057-3604
US

V. Phone/Fax

Practice location:
  • Phone: 972-221-6005
  • Fax:
Mailing address:
  • Phone: 972-221-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1096570
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: