Healthcare Provider Details

I. General information

NPI: 1508340050
Provider Name (Legal Business Name): HANNAH PHAM DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 SEVERN AVE
METAIRIE LA
70002
US

IV. Provider business mailing address

3501 SEVERN AVE
METAIRIE LA
70002-3451
US

V. Phone/Fax

Practice location:
  • Phone: 504-835-0565
  • Fax:
Mailing address:
  • Phone: 504-835-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200210
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number200210
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: