Provider Demographics
NPI:1083917157
Name:PHAM, VIRGINIA (RN, EAMP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:RN, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S LLOYD LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7056
Mailing Address - Country:US
Mailing Address - Phone:509-294-4907
Mailing Address - Fax:
Practice Address - Street 1:501 S BERNARD ST STE 217
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2508
Practice Address - Country:US
Practice Address - Phone:509-294-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATP60198313171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist