Healthcare Provider Details

I. General information

NPI: 1730654229
Provider Name (Legal Business Name): LINH THI THUY VU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13065 W MCDOWELL RD STE A105
AVONDALE AZ
85392
US

IV. Provider business mailing address

13065 W MCDOWELL RD STE A105
AVONDALE AZ
85392-6440
US

V. Phone/Fax

Practice location:
  • Phone: 235-366-7886
  • Fax: 623-935-4370
Mailing address:
  • Phone: 623-536-6788
  • Fax: 623-935-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218135
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: