Doctor Name: | PHUONG PHAN |
NPI Number: | 1033466040 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | RN2272283 |
Business Practice Address: | 529 Main St Suite 216 Charlestown, MA - 021291125 |
Business Phone Number: | 6178956488 |
Business Fax Number: | |
Mailing Address: | 176 Charger St, REVERE |
State: | MA |
Postal Code: | 021512003 |
Phone Number: | 6179387847 |
Fax Number: | |
NPI Enumeration Date: | 08/08/2012 |
NPI Last Update Date: | 08/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN2272283 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |