1932583291 NPI number — OANH NGUYEN PA

Table of content: OANH NGUYEN PA (NPI 1932583291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932583291 NPI number — OANH NGUYEN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
OANH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
JACKIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1932583291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2104 GAUSE BLVD W
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70460-4130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-643-4575
Provider Business Mailing Address Fax Number:
504-643-4513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3715 WILLIAMS BLVD
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
KENNER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70065-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-464-4550
Provider Business Practice Location Address Fax Number:
504-465-8590
Provider Enumeration Date:
07/16/2015

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: 363AM0700X , with the licence number:  PA.200859 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA.200859 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2400118 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06631011 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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