MEDICARE: RACHEL LU NGUYEN PA-C

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	363A00000X	Physician Assistant	14661	MN

General Provider Information

NPI Number	:	1053196022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LU NGUYEN PA-C

Provider Business Mailing Address
First Line	:	10001 W INNOVATION DR STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4851
Country	:	US
Telephone Number	:	888-938-3838
Fax Number	:	888-919-1083

Provider Business Practice Location Address
First Line	:	845 VIKINGS PKWY STE B
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-1139
Country	:	US
Telephone Number	:	888-938-3838
Fax Number	:	888-919-1083

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

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	11/20/2024

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