MEDICARE: THANH THI BAC NGUYEN FNP

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	090000179N1	OR
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0031988	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00252360	OTHER	OR	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447241666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANH THI BAC NGUYEN FNP

Provider Business Mailing Address
First Line	:	1064 STATE ROUTE 28 UNIT F
Second Line	:
City	:	MILFORD
State	:	OH
Zip	:	45150-4940
Country	:	US
Telephone Number	:	513-981-4050
Fax Number	:	513-322-4859

Provider Business Practice Location Address
First Line	:	1064 STATE ROUTE 28 UNIT F
Second Line	:
City	:	MILFORD
State	:	OH
Zip	:	45150-4940
Country	:	US
Telephone Number	:	513-981-4050
Fax Number	:	513-322-4859

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	09/14/2024

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Directions to “ THANH THI BAC NGUYEN FNP” Practice Location

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