Basic Information
| Provider Information | |||||||||
| NPI: | 1306503016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | THU | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13202 CHESTNUT FIELD CT | ||||||||
| Address2: | |||||||||
| City: | ROSHARON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775830378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323430405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 905 N GULF BLVD | ||||||||
| Address2: | |||||||||
| City: | FREEPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775413907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818241480 | ||||||||
| FaxNumber: | 2812206407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2021 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0400X | 850233 | TX | N | Nursing Service Providers | Registered Nurse | Rehabilitation | 363LF0000X | 1074021 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.