Provider Demographics
NPI:1538894142
Name:NGUYEN, QUYEN MONG (PA-C)
Entity type:Individual
Prefix:
First Name:QUYEN
Middle Name:MONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 PERKINS RD APT 834
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9197
Mailing Address - Country:US
Mailing Address - Phone:337-781-0438
Mailing Address - Fax:
Practice Address - Street 1:1818 S SHERWOOD FOREST BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8321
Practice Address - Country:US
Practice Address - Phone:225-256-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA332733OtherLICENSE NUMBER