MEDICARE: AMANDA NGUYEN CPNP

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	363LP0200X	Pediatric Nurse Practitioner	583796	TX

General Provider Information

NPI Number	:	1871532127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NGUYEN CPNP

Provider Business Mailing Address
First Line	:	PO BOX 841969
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-1969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5610 W RIVER PARK DR
Second Line	:	SUITE A
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-7901
Country	:	US
Telephone Number	:	281-494-8687
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/08/2013

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