MEDICARE: KATHERINE H NGUYEN PA

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	363A00000X	Physician Assistant	0110-001392	VA

General Provider Information

NPI Number	:	1841243094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE H NGUYEN PA

Provider Business Mailing Address
First Line	:	5127 VERONICA RD
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20120-6435
Country	:	US
Telephone Number	:	703-830-7093
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 N ST SE BLDG 175
Second Line	:	WASHINGTON NAVY YARD
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5162
Country	:	US
Telephone Number	:	202-433-3132
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/26/2013

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