Healthcare Provider Details

I. General information

NPI: 1659801959
Provider Name (Legal Business Name): PHUONG TU TRUONG MSN, FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 04/05/2020
Certification Date: 04/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 KISSENA BLVD # F1
FLUSHING NY
11355-3213
US

IV. Provider business mailing address

4266 KISSENA BLVD FL 1
FLUSHING NY
11355-3213
US

V. Phone/Fax

Practice location:
  • Phone: 718-333-5537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number716785
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342634
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: