Individual
MS. AUTUMN NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
38935 ANN ARBOR RD, CREDENTIALING/PAYER ENROLLMENT DEPT, LIVONIA, MI 48150-3397
(734) 632-0175
(734) 805-0489
Mailing address
601 PARK ST, EMERGENCY DEPARTMENT, HONESDALE, PA 18431-1445
(570) 253-8140
(570) 253-8633
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA055123
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA055123
STATE LICENSE
PA
01
—
PENDING
CAQH
PA
Enumeration date
09/27/2011
Last updated
02/17/2020
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