Healthcare Provider Details

I. General information

NPI: 1992109698
Provider Name (Legal Business Name): MR. ANTHONY NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 BELMONT AVE UNIT 421
SEATTLE WA
98122
US

IV. Provider business mailing address

4800 SAND POINT WAY NE M/S RC 406
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 425-246-1216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041406451
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60066998
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60517542
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: