Healthcare Provider Details

I. General information

NPI: 1912027509
Provider Name (Legal Business Name): KIEUANH T PHAM R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIEUANH T PHAM RN

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20012 N 35TH AVE
GLENDALE AZ
85308-2204
US

IV. Provider business mailing address

7734 W MCRAE WAY
GLENDALE AZ
85308-5917
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-4110
  • Fax:
Mailing address:
  • Phone: 623-215-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN129491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: