Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN188608 | GA |
NPI | 1023368040 |
---|---|
Provider Name | Mariana Thuyen Nguyen |
First Address | Macon, GA 31208-4363 |
Second Address | Macon, GA 31201-7307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2012 |
Last Update Date | 28/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003146216A | (05) | GA |
202I504405 | (02) | GA |