Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP143282 | TX |
NPI | 1477182426 |
---|---|
Provider Name | Amy Thienphuong Nguyen |
First Address | Grand Prairie, TX 75052-3037 |
Second Address | Dallas, TX 75203-1201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2020 |
Last Update Date | 02/04/2020 |