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NPI Code Detail

MEDICARE: QUYEN MONG NGUYEN PA-C

MEDICARE: QUYEN MONG 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
1363A00000XPhysician Assistant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1332733OTHERLALICENSE NUMBER

General Provider Information

NPI Number : 1538894142
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUYEN MONG NGUYEN PA-C
Provider Business Mailing Address
First Line : 7250 PERKINS RD APT 834
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-9197
Country : US
Telephone Number : 337-781-0438
Fax Number :
Provider Business Practice Location Address
First Line : 1818 S SHERWOOD FOREST BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-8321
Country : US
Telephone Number : 225-256-5888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2022
Last Update Date : 08/10/2022

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Directions to “ QUYEN MONG NGUYEN PA-C” Practice Location

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