Basic Information
Provider Information
NPI: 1699432666
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NGUYEN
FirstName: UYEN
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: ARNP, DNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 25608
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841250608
CountryCode: US
TelephoneNumber: 2063204476
FaxNumber: 2065687043
Practice Location
Address1: 515 MINOR AVE STE 300
Address2:  
City: SEATTLE
State: WA
PostalCode: 981042133
CountryCode: US
TelephoneNumber: 2063869500
FaxNumber: 2063869605
Other Information
ProviderEnumerationDate: 11/24/2021
LastUpdateDate: 02/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN60297899WAN Nursing Service ProvidersRegistered Nurse 
363LF0000X61199915WAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LP2300XAP61199915WAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
363L00000XAP61199915WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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