MEDICARE: LAN THI VU NP

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	363LW0102X	Women's Health Nurse Practitioner	RN134131 NP	GA

General Provider Information

NPI Number	:	1730188004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAN THI VU NP

Provider Business Mailing Address
First Line	:	2750 OWENS DRIVE
Second Line	:	SUITE A
City	:	CONYERS
State	:	GA
Zip	:	30094
Country	:	US
Telephone Number	:	678-413-4644
Fax Number	:	678-413-4624

Provider Business Practice Location Address
First Line	:	2750 OWENS DRIVE
Second Line	:	SUITE A
City	:	CONYERS
State	:	GA
Zip	:	30094
Country	:	US
Telephone Number	:	678-413-4644
Fax Number	:	678-413-4624

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	01/24/2011

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