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General NPI Number Information
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NPI Number | 1952821035
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Entity Type | Individual
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Provider Name | VANESSA TRAN PHAN-DANG FNP
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 57850 VAN DYKE RD
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City | WASHINGTON
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State | MI
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Zip | 48094-3826
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Country | US
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Telephone | 586-935-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 8812 RIDGE DR
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City | WASHINGTON
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State | MI
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Zip | 48095
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Country | US
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Telephone | 616-885-7772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704290137
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License Number State | MI
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