Healthcare Provider Details

I. General information

NPI: 1407570476
Provider Name (Legal Business Name): THERESA VU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 INTREPID AVE
PHILADELPHIA PA
19112-1229
US

IV. Provider business mailing address

3724 E C ST
TACOMA WA
98404-1527
US

V. Phone/Fax

Practice location:
  • Phone: 800-748-3243
  • Fax:
Mailing address:
  • Phone: 253-906-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN61152670
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: