Provider Demographics
NPI:1225877632
Name:NGUYEN, PHUC HA PHUONG (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:PHUC HA PHUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 TURNPIKE ST STE 33
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2856
Mailing Address - Country:US
Mailing Address - Phone:781-236-7343
Mailing Address - Fax:781-806-1026
Practice Address - Street 1:1017 TURNPIKE ST STE 33
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2856
Practice Address - Country:US
Practice Address - Phone:781-236-7343
Practice Address - Fax:781-806-1026
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2326473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health