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General NPI Number Information
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NPI Number | 1104652296
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Entity Type | Individual
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Provider Name | JEANNIE LAN NGUYEN
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Gender | Female
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 120 OCHSNER BLVD
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City | GRETNA
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State | LA
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Zip | 70056-5255
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Country | US
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Telephone | 504-595-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 FORDHAM PL
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City | GRETNA
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State | LA
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Zip | 70056-4027
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Country | US
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Telephone | 504-453-4159
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 343933
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License Number State | LA
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