Provider Demographics
NPI:1609502020
Name:NGUYEN, SALLY U (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:U
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 W LULLABY LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5560
Mailing Address - Country:US
Mailing Address - Phone:714-588-2533
Mailing Address - Fax:
Practice Address - Street 1:7724 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2509
Practice Address - Country:US
Practice Address - Phone:951-977-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily