Provider Demographics
NPI:1386928513
Name:NGUYEN, OANH HOANG (LPN)
Entity type:Individual
Prefix:
First Name:OANH
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:OANH
Other - Middle Name:MARYANN HOANG
Other - Last Name:VO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:740 JACKSON BANK PL NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6067
Mailing Address - Country:US
Mailing Address - Phone:678-523-0811
Mailing Address - Fax:770-638-4631
Practice Address - Street 1:740 JACKSON BANK PL NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6067
Practice Address - Country:US
Practice Address - Phone:678-523-0811
Practice Address - Fax:770-638-4631
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053173339347C00000X
GALPN073491164W00000X
3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider