Doctor Name: | LIEU PHAM |
NPI Number: | 1609260173 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 26NJ00609800 |
Business Practice Address: | 700 Town Bank Rd North Cape May, NJ - 082044411 |
Business Phone Number: | 6098988899 |
Business Fax Number: | |
Mailing Address: | 31 Equestrian Rd, EGG HARBOR TOWNSHIP |
State: | NJ |
Postal Code: | 082348006 |
Phone Number: | 6098293024 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2015 |
NPI Last Update Date: | 03/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 26NJ00609800 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |