Most Relevant Information
Provider Data
| NPI Number: | 1003264250 |
| Provider Name: | QUYEN LE TA NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | RN211447 |
Most Important Dates
| Enumeration Date: | 05/28/2016 |
| Last Updated: | 05/28/2016 |
Provider Practice Location
2628 MYRTLEWOOD LN NW
KENNESAW
GA
301447395
Practice Location Phone/Fax
| Phone: | 4043249413 |
| Fax: |
Provider Mailing Location
2628 MYRTLEWOOD LN NW
KENNESAW
GA
301447395
Provider Mailing Phone/Fax
| Phone: | 4043249413 |
| Fax: |