Provider Demographics
NPI:1154194553
Name:NGUYEN, QUYNH NGOC PHUONG
Entity type:Individual
Prefix:
First Name:QUYNH
Middle Name:NGOC PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 WOODPARK DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7882
Mailing Address - Country:US
Mailing Address - Phone:972-467-4195
Mailing Address - Fax:
Practice Address - Street 1:2602 WOODPARK DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7882
Practice Address - Country:US
Practice Address - Phone:972-467-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1040222163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health