Provider Demographics
NPI:1114301330
Name:COURTNEY, PHUONG TRAN (PA)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:TRAN
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:THI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1613 NORTH ATHERTON STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803
Mailing Address - Country:US
Mailing Address - Phone:814-238-1066
Mailing Address - Fax:
Practice Address - Street 1:1613 NORTH ATHERTON STREET
Practice Address - Street 2:SUITE B
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-238-1066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant