1457593105 NPI number — MRS. CHI LAN NGUYEN-JOHNSON PHARMD

Table of content: MARK ANDREW RAINSDON LCSW (NPI 1982179727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457593105 NPI number — MRS. CHI LAN NGUYEN-JOHNSON PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN-JOHNSON
Provider First Name:
CHI
Provider Middle Name:
LAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
CHI
Provider Other Middle Name:
LAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457593105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 WILFORD HALL LOOP
Provider Second Line Business Mailing Address:
BLDG 4554
Provider Business Mailing Address City Name:
JBSA-LACKLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-292-4808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 WILFORD HALL LOOP
Provider Second Line Business Practice Location Address:
BLDG 4554
Provider Business Practice Location Address City Name:
JBSA-LACKLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-292-4808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  13698 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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