Provider Demographics
NPI:1902896681
Name:VU, NGA (FNP)
Entity Type:Individual
Prefix:
First Name:NGA
Middle Name:
Last Name:VU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4640
Mailing Address - Country:US
Mailing Address - Phone:503-807-6657
Mailing Address - Fax:
Practice Address - Street 1:9775 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5739
Practice Address - Country:US
Practice Address - Phone:503-654-8417
Practice Address - Fax:503-654-8218
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR093000591N1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126370Medicaid