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NPI Code Detail

MEDICARE: LY NGOC THI NGUYEN PA

MEDICARE: LY NGOC THI 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
1363A00000XPhysician Assistant0010-16257NC

General Provider Information

NPI Number : 1871450155
Entity Type Code : Individual
Provider Name (Legal Business Name) : LY NGOC THI NGUYEN PA
Provider Business Mailing Address
First Line : 4420 LAKE BOONE TRL
Second Line :
City : RALEIGH
State : NC
Zip : 27607-7505
Country : US
Telephone Number : 919-784-3542
Fax Number : 919-784-5605
Provider Business Practice Location Address
First Line : 4420 LAKE BOONE TRL
Second Line :
City : RALEIGH
State : NC
Zip : 27607-7505
Country : US
Telephone Number : 919-784-5380
Fax Number : 919-784-5605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 03/11/2026

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Directions to “ LY NGOC THI NGUYEN PA” Practice Location

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