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General NPI Number Information
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NPI Number | 1558866988
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Entity Type | Individual
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Provider Name | MARANDA NGUYEN DO
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Gender | Female
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 11725 W 112TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66210-2761
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Country | US
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Telephone | 913-469-5579
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Fax | 913-338-1311
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Provider Business Mailing Address
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Address Line | PO BOX 741331
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City | ATLANTA
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State | GA
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Zip | 30374-1331
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Country | US
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Telephone | 913-469-0503
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Fax | 913-338-1311
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2021025345
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05-46896
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License Number State | KS
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