Provider Demographics
NPI:1730188004
Name:VU, LAN THI (NP)
Entity type:Individual
Prefix:
First Name:LAN
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 1:2750 OWENS DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094
Mailing Address - Country:US
Mailing Address - Phone:678-413-4644
Mailing Address - Fax:678-413-4624
Practice Address - Street 1:2750 OWENS DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:678-413-4644
Practice Address - Fax:678-413-4624
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134131 NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q50231Medicare UPIN
GA50BBJRBMedicare PIN