Provider Demographics
NPI:1912790122
Name:NGUYEN, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NGUYEN
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 1:2600 N LIMESTONE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1120
Mailing Address - Country:US
Mailing Address - Phone:937-523-9980
Mailing Address - Fax:937-523-9985
Practice Address - Street 1:2600 N LIMESTONE ST STE 150
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1120
Practice Address - Country:US
Practice Address - Phone:937-523-9980
Practice Address - Fax:937-523-9985
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.009731RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant