Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 7093-15 | WI |
Y | 1223G0001X | General Practice | 7093-15 | WI |
Y | 213EG0000X | General Practice | 7093-15 | WI |
NPI | 1275971921 |
---|---|
Provider Name | Dr. Thao Thi-Thanh Nguyen |
First Address | Oneida, WI 54155-9035 |
Second Address | Oneida, WI 54155-9035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2013 |
Last Update Date | 12/04/2018 |