Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 757940 | TX |
NPI | 1134464621 |
---|---|
Provider Name | John Nguyen |
First Address | Dallas, TX 75235-7708 |
Second Address | Dallas, TX 75235-7708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2012 |
Last Update Date | 10/12/2012 |