=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083917157
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIRGINIA PHAM RN, EAMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2010
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2204 E 29TH AVE STE 208
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99203-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-294-4907
-----------------------------------------------------
Fax | 509-534-2075
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3303 S LLOYD LN
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99223-7056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-294-4907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | TP60198313
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------