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NPI Code Detail

MEDICARE: THANH LAN NGUYEN PA

MEDICARE: THANH LAN NGUYEN PA
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
1363A00000XPhysician AssistantPA07204TX

General Provider Information

NPI Number : 1104105485
Entity Type Code : Individual
Provider Name (Legal Business Name) : THANH LAN NGUYEN PA
Provider Business Mailing Address
First Line : PO BOX 772
Second Line :
City : WOONSOCKET
State : RI
Zip : 02895-0784
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-652-9787
Provider Business Practice Location Address
First Line : 460 NORTHWEST PKWY
Second Line :
City : AZLE
State : TX
Zip : 76020-3136
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-652-9787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 08/04/2011

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Directions to “ THANH LAN NGUYEN PA” Practice Location

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