Individual
DIANE NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1055 N 500 W, STE 212 BLDG C, PROVO, UT 84604
(801) 374-2362
(801) 429-8050
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13595780-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/03/2022
Last updated
02/04/2025
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