Healthcare Provider Details

I. General information

NPI: 1407917594
Provider Name (Legal Business Name): THUY MY VU MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 S. JEFFERSON ST. CARILION CLINIC CANCER GENETICS PROGRAM
ROANOKE VA
24016-4705
US

IV. Provider business mailing address

MEDICAL CENTER BLVD WAKE FOREST BAPTIST HEALTH COMPREHENSIVE CANCER CENTER
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 540-521-9941
  • Fax: 540-857-9130
Mailing address:
  • Phone: 336-713-6980
  • Fax: 336-713-6797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: