Provider Demographics
NPI:1568627560
Name:NGO-NGUYEN, PHUONG-LIEN THI (RN)
Entity type:Individual
Prefix:MRS
First Name:PHUONG-LIEN
Middle Name:THI
Last Name:NGO-NGUYEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PHUONG-LIEN
Other - Middle Name:THI
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15141 PALOMINO MESA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-4429
Mailing Address - Country:US
Mailing Address - Phone:858-673-0877
Mailing Address - Fax:
Practice Address - Street 1:15141 PALOMINO MESA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-4429
Practice Address - Country:US
Practice Address - Phone:858-673-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN264867163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse