MEDICARE: TAEWON NADINE PHANGLYN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	304940	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538529433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAEWON NADINE PHANGLYN

Provider Business Mailing Address
First Line	:	285 EASTERN PARKWAY
Second Line	:	APT 9
City	:	BROOKLYN
State	:	NY
Zip	:	11238
Country	:	US
Telephone Number	:	610-991-6167
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 EASTERN PKWY
Second Line	:	APT 9
City	:	BROOKLYN
State	:	NY
Zip	:	11238-6374
Country	:	US
Telephone Number	:	610-991-6167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	03/04/2016

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