Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP018216 | PA |
NPI | 1013423441 |
---|---|
Provider Name | Angela Le Nguyen |
First Address | Philadelphia, PA 19104-4238 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2017 |
Last Update Date | 21/12/2017 |