Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 364 | OK |
Y | 222Z00000X | Podiatrist | 364 | OK |
NPI | 1023472487 |
---|---|
Provider Name | Ann Nguyen |
First Address | Tahlequah, OK 74464-0545 |
Second Address | Tahlequah, OK 74464-0545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2016 |
Last Update Date | 19/05/2021 |