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General NPI Number Information
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NPI Number | 1467965632
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Entity Type | Individual
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Provider Name | MRS. THUY NGOC LY
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Gender | Female
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 186 MEADOWVIEW LN
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City | WARRENTON
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State | VA
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Zip | 20186-3847
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Country | US
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Telephone | 703-627-9321
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Fax |
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Provider Business Mailing Address
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Address Line | 186 MEADOWVIEW LN
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City | WARRENTON
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State | VA
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Zip | 20186-3847
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Country | US
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Telephone | 703-627-9321
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | 984863
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License Number State | VA
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