Healthcare Provider Details

I. General information

NPI: 1104442482
Provider Name (Legal Business Name): HA DUC SEUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 W HEATHERBRAE DR
PHOENIX AZ
85015-4764
US

IV. Provider business mailing address

1847 W HEATHERBRAE DR
PHOENIX AZ
85015-4764
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-2100
  • Fax: 602-535-3166
Mailing address:
  • Phone: 602-274-2100
  • Fax: 602-535-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number241585
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: