MEDICARE: DOAN TRINH THUY PHAM FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	F11220958	VA

General Provider Information

NPI Number	:	1053021139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOAN TRINH THUY PHAM FNP-C

Provider Business Mailing Address
First Line	:	12027 CHEVIOT DR
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-2702
Country	:	US
Telephone Number	:	703-725-0268
Fax Number	:

Provider Business Practice Location Address
First Line	:	12027 CHEVIOT DR
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-2702
Country	:	US
Telephone Number	:	703-725-0268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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