Provider Demographics
NPI:1972106474
Name:VU, BAO NGOC THI (NP)
Entity type:Individual
Prefix:
First Name:BAO NGOC
Middle Name:THI
Last Name:VU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CANDLER CT
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3303
Mailing Address - Country:US
Mailing Address - Phone:404-512-9180
Mailing Address - Fax:
Practice Address - Street 1:1320 CANDLER CT
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3303
Practice Address - Country:US
Practice Address - Phone:404-512-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF07202164363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner