| Doctor Name: | MRS. QUYEN LE TA |
| NPI Number: | 1003264250 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | RN211447 |
| Business Practice Address: | 2628 Myrtlewood Ln Nw Kennesaw, GA - 301447395 |
| Business Phone Number: | 4043249413 |
| Business Fax Number: | |
| Mailing Address: | 2628 Myrtlewood Ln Nw, KENNESAW |
| State: | GA |
| Postal Code: | 301447395 |
| Phone Number: | 4043249413 |
| Fax Number: | |
| NPI Enumeration Date: | 05/28/2016 |
| NPI Last Update Date: | 05/28/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN211447 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |