=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538161203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUYNH DONA VO NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 11/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4444 N 32ND ST STE 175
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85018-3999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-952-0002
-----------------------------------------------------
Fax | 602-224-9119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4444 N 32ND ST STE 175
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85018-3999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-952-0002
-----------------------------------------------------
Fax | 602-224-9119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN078856
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | AP1931
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------