Provider Demographics
NPI:1326472002
Name:NGUYEN, LAN NGOC (FNP/APRN)
Entity type:Individual
Prefix:MRS
First Name:LAN
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 S 74TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5170
Mailing Address - Country:US
Mailing Address - Phone:479-314-4620
Mailing Address - Fax:479-314-4630
Practice Address - Street 1:2713 S 74TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5170
Practice Address - Country:US
Practice Address - Phone:479-314-4620
Practice Address - Fax:479-314-4630
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5463364SP0200X, 363L00000X
CT005463363LF0000X
ARA006245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1326472002OtherANTHEM BCBS
CT561230OtherCONNECTICARE
CT004236130Medicaid
CT561230OtherCONNECTICARE