Healthcare Provider Details

I. General information

NPI: 1033823273
Provider Name (Legal Business Name): GWEN NGUYEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S 10TH ST
MILWAUKEE WI
53221-2412
US

IV. Provider business mailing address

6517 FIELDSTONE CT
RACINE WI
53402-9401
US

V. Phone/Fax

Practice location:
  • Phone: 414-744-5370
  • Fax:
Mailing address:
  • Phone: 262-633-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number233523
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number233523-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: