Provider Demographics
NPI:1235686429
Name:NGUYEN, LAN CHI THI (MA, RD)
Entity type:Individual
Prefix:
First Name:LAN CHI
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14743 TAMARACK PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3135
Mailing Address - Country:US
Mailing Address - Phone:240-601-4097
Mailing Address - Fax:
Practice Address - Street 1:14743 TAMARACK PL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3135
Practice Address - Country:US
Practice Address - Phone:240-601-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012253133V00000X
DC01012253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered