Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F401940-1 | NY |
NPI | 1033665864 |
---|---|
Provider Name | Thao Nguyen |
First Address | Selden, NY 11784-2550 |
Second Address | West Islip, NY 11795-4429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 14/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04591291 | (05) | NY |