Provider Demographics
NPI:1871209221
Name:NGUYEN, LUC T (AGNP)
Entity type:Individual
Prefix:MR
First Name:LUC
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-7216
Mailing Address - Fax:314-362-8826
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV IM HEMATOLOGY, STE 7A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7216
Practice Address - Fax:314-362-8826
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022049033363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420122215Medicaid