MEDICARE: THUY VUONG NGUYEN TRAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	12076652-4405	UT
2	363L00000X	Nurse Practitioner	12076652-4405	UT

General Provider Information

NPI Number	:	1013716703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THUY VUONG NGUYEN TRAN

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5373 W LAKE PARK BLVD
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-8208
Country	:	US
Telephone Number	:	801-902-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	12/10/2025

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