Provider Demographics
NPI:1801362108
Name:NGUYEN, OLIVIA THUY (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:THUY
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 1:3400 N DYSART RD STE G127
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1011
Mailing Address - Country:US
Mailing Address - Phone:623-322-0323
Mailing Address - Fax:623-322-0757
Practice Address - Street 1:3400 N DYSART RD STE G127
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1011
Practice Address - Country:US
Practice Address - Phone:623-322-0323
Practice Address - Fax:623-322-0757
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 390200000X
AZPENDING363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program