Healthcare Provider Details

I. General information

NPI: 1922498559
Provider Name (Legal Business Name): TOAN QUOC NGUYEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOUTH 43RD STREET VALLEY MEDICAL CENTER HELIPORT
RENTON WA
98055-5714
US

IV. Provider business mailing address

400 S 43RD ST VALLEY MEDICAL CENTER HELIPORT
RENTON WA
98055-5714
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-5180
  • Fax:
Mailing address:
  • Phone: 425-251-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105630
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: