Provider Demographics
NPI:1538748645
Name:NGUYEN, AI VAN VO
Entity type:Individual
Prefix:
First Name:AI VAN
Middle Name:VO
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 1:7107 ZUEFELDT DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-3813
Mailing Address - Country:US
Mailing Address - Phone:682-225-7155
Mailing Address - Fax:
Practice Address - Street 1:209 CHASEMORE LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1084
Practice Address - Country:US
Practice Address - Phone:682-225-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
TX226675183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No374U00000XNursing Service Related ProvidersHome Health Aide