MEDICARE: MRS. HA DIEU NGUYEN RONI ARNP

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	363LP0200X	Pediatric Nurse Practitioner	AP30007973	WA

General Provider Information

NPI Number	:	1215118815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HA DIEU NGUYEN RONI ARNP

Provider Business Mailing Address
First Line	:	4744 41ST AVE SW STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4566
Country	:	US
Telephone Number	:	206-320-5780
Fax Number	:	206-320-5794

Provider Business Practice Location Address
First Line	:	4744 41ST AVE SW STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4566
Country	:	US
Telephone Number	:	206-320-5780
Fax Number	:	206-320-5794

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

Provider Enumeration Date	:	11/25/2007
Last Update Date	:	10/13/2020

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