Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2502 | IA |
NPI | 1013033075 |
---|---|
Provider Name | Heather Yvonne Nguyen |
First Address | Cedar Rapids, IA 52403-1632 |
Second Address | Cedar Rapids, IA 52404-7818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013033075 | (05) | IA |
IB1603004 | (02) | IA |