Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | GETP.201540 | LA |
NPI | 1003202128 |
---|---|
Provider Name | Michael Nguyen |
First Address | Kenner, LA 70065 |
Second Address | Slidell, LA 70458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 19/07/2018 |