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General NPI Number Information
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NPI Number | 1053614743
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Entity Type | Organization
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Legal Business Name | PHUONG T NGUYEN
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8600 RAVENSWOOD CIR
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City | WAUWATOSA
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State | WI
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Zip | 53226-4658
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Country | US
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Telephone | 414-258-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 8600 RAVENSWOOD CIR
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City | WAUWATOSA
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State | WI
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Zip | 53226-4658
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Country | US
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Telephone | 414-258-2005
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MRS. PHUONG THI NGUYEN
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Credential | NURSING
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Telephone | 414-258-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | WI
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