MEDICARE: MR. QUANG HO RN

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	4704319450	MI
2	163W00000X	Registered Nurse	4704319450	MI

General Provider Information

NPI Number	:	1427700780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. QUANG HO RN

Provider Business Mailing Address
First Line	:	3215 N ALTADENA AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3557
Country	:	US
Telephone Number	:	616-990-1841
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 N ALTADENA AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3557
Country	:	US
Telephone Number	:	616-990-1841
Fax Number	:

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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Directions to “ MR. QUANG HO RN” Practice Location

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