Provider Demographics
NPI:1720814957
Name:TRA, DIEM-MI NGUYEN
Entity type:Individual
Prefix:
First Name:DIEM-MI
Middle Name:NGUYEN
Last Name:TRA
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 1:7118 WOODSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6015
Mailing Address - Country:US
Mailing Address - Phone:704-533-1647
Mailing Address - Fax:
Practice Address - Street 1:7118 WOODSTREAM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6015
Practice Address - Country:US
Practice Address - Phone:704-533-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant