Individual
MRS. LAN NGOC NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP/APRN
Contact information
Practice address
2713 S 74TH ST, FORT SMITH, AR 72903-5170
(479) 314-4620
(479) 314-4630
Mailing address
2713 S 74TH ST, FORT SMITH, AR 72903-5170
(479) 314-4620
(479) 314-4630
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A006245
AR
363L00000X
Nurse Practitioner
5463
CT
363LF0000X
Family Nurse Practitioner
005463
CT
364SP0200X
Pediatric Clinical Nurse Specialist
5463
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236130
—
CT
01
—
1326472002
ANTHEM BCBS
CT
01
—
561230
CONNECTICARE
CT
Enumeration date
08/29/2013
Last updated
12/16/2024
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