Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | N006821 | NY |
Y | 213ES0103X | Foot & Ankle Surgery | N006821 | NY |
N | 213ES0131X | Foot Surgery | N006821 | NY |
NPI | 1497154371 |
---|---|
Provider Name | Thao Linh Nguyen |
First Address | Dunlap, IL 61525-9664 |
Second Address | Peoria, IL 61615-9323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 07/03/2019 |