Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1700438231 |
---|---|
Provider Name | J Quyen Vu Alexander Nichols |
First Address | Vienna, VA 22181-5369 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2019 |
Last Update Date | 15/07/2019 |