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NPI Code Detail

MEDICARE: ROSE PHAM

MEDICARE: ROSE PHAM
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
1163W00000XRegistered Nurse938008TX
2363LF0000XFamily Nurse Practitioner1112067TX

General Provider Information

NPI Number : 1467150185
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSE PHAM
Provider Business Mailing Address
First Line : 1915 E MAYFIELD RD STE 115
Second Line :
City : ARLINGTON
State : TX
Zip : 76014-2605
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1915 E MAYFIELD RD STE 115
Second Line :
City : ARLINGTON
State : TX
Zip : 76014-2605
Country : US
Telephone Number : 682-276-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2023
Last Update Date : 03/01/2023

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Directions to “ ROSE PHAM ” Practice Location

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