Provider Demographics
NPI:1366091662
Name:NGUYEN, THANH VAN (FNP-C)
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 COUNTY ROUTE 47 APT 3
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13668-3256
Mailing Address - Country:US
Mailing Address - Phone:315-982-0409
Mailing Address - Fax:
Practice Address - Street 1:3098 COUNTY ROUTE 47 APT 3
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NY
Practice Address - Zip Code:13668-3256
Practice Address - Country:US
Practice Address - Phone:315-982-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357329363LF0000X
NY631278163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse