Provider Demographics
NPI:1104245273
Name:NGUYEN, SUN LEE (CRNP)
Entity type:Individual
Prefix:
First Name:SUN
Middle Name:LEE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 E BEN FRANKLIN HWY
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508
Mailing Address - Country:US
Mailing Address - Phone:610-288-2908
Mailing Address - Fax:610-898-4832
Practice Address - Street 1:258 E BEN FRANKLIN HWY
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-8772
Practice Address - Country:US
Practice Address - Phone:610-288-2908
Practice Address - Fax:610-898-4832
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA357315Medicare PIN