Individual
THAO TP NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
402 W LAKE ST, FRIENDSHIP, WI 53934-9699
(608) 339-3331
Mailing address
402 W LAKE ST, FRIENDSHIP, WI 53934-9699
(608) 339-3331
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
62437
WI
207Q00000X
Family Medicine Physician
DO25094
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275291
—
OR
01
—
P00458926
RR MEDICARE
OR
Enumeration date
07/11/2006
Last updated
10/04/2021
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