MEDICARE: MISS PHUNG VO NP-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	363LF0000X	Family Nurse Practitioner	786709	TX
2	363LF0000X	Family Nurse Practitioner	AP132768	TX

General Provider Information

NPI Number	:	1114460532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PHUNG VO NP-C

Provider Business Mailing Address
First Line	:	5907 CIELO RNCH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-4164
Country	:	US
Telephone Number	:	972-342-8410
Fax Number	:

Provider Business Practice Location Address
First Line	:	8235 S NEW BRAUNFELS STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78235-4439
Country	:	US
Telephone Number	:	210-616-1317
Fax Number	:	210-333-0633

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

Provider Enumeration Date	:	12/03/2016
Last Update Date	:	10/03/2019

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