Healthcare Provider Details

I. General information

NPI: 1972254746
Provider Name (Legal Business Name): LAN HOANG PHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 VICTORIA STREET VICTORIA BUILDING 360A
PITTSBURGH PA
15261-0001
US

IV. Provider business mailing address

612 BROADHEAD AVE APT 4
PITTSBURGH PA
15205-2866
US

V. Phone/Fax

Practice location:
  • Phone: 888-747-0794
  • Fax:
Mailing address:
  • Phone: 717-419-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN709272
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: