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General NPI Number Information
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NPI Number | 1629752530
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Entity Type | Individual
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Provider Name | LYAN NGUYEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 999 DALTON AVE
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City | PITTSFIELD
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State | MA
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Zip | 01201-2903
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Country | US
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Telephone | 413-242-6577
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Fax |
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Provider Business Mailing Address
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Address Line | 360 US HIGHWAY 1 BYP UNIT 102
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City | PORTSMOUTH
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State | NH
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Zip | 03801-7105
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Country | US
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Telephone | 603-319-4490
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA102048
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License Number State | MA
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