Healthcare Provider Details

I. General information

NPI: 1295345163
Provider Name (Legal Business Name): ANH TUYET VUONG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E CAMELBACK RD # 8366
PHOENIX AZ
85016-3902
US

IV. Provider business mailing address

1610 E CAMELBACK RD # 8366
PHOENIX AZ
85016-3902
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-1727
  • Fax:
Mailing address:
  • Phone: 602-277-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number241812
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241812
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: