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General NPI Number Information
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NPI Number | 1992320725
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Entity Type | Organization
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Legal Business Name | THAO NGUYEN NURSE PRACTITIONER IN PSYCHIATRY PC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 12 FAIRWOOD LN
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City | CORAM
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State | NY
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Zip | 11727-3336
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Country | US
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Telephone | 631-318-4004
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Fax | 631-318-6443
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Provider Business Mailing Address
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Address Line | 1070 MIDDLE COUNTRY RD STE 7-271
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City | SELDEN
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State | NY
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Zip | 11784-2580
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Country | US
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Telephone | 516-398-6691
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Fax | 631-318-6443
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Authorized Official
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Title or Position | OWNER
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Name | THAO NGUYEN
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Credential | NP
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Telephone | 631-318-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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