Basic Information
| Provider Information | |||||||||
| NPI: | 1497746648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | ANH | ||||||||
| MiddleName: | X | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2024 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | BRAINERD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564014529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 6TH AVE N | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 38555 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | HP31010 | 01 | HEALTH PARTNERS | OTHER | 2116694 | 01 | FIRST HEALTH PLAN | OTHER | 1025056 | 01 | PREFERRED ONE | OTHER | 91D76NG | 01 | BLUE CROSS BLUE SHIELD | OTHER | 0500112 | 01 | MEDICA HEALTH PLANS | OTHER | 1079982 | 01 | ARAZ GROUP/AMERICA'S PPO | OTHER | 140078 | 01 | U-CARE | OTHER | 944602800 | 01 | MEDICAL ASSISTANCE (MA) | OTHER |