Provider Demographics
NPI:1467889923
Name:PHAM, VAN THI KIM (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VAN
Middle Name:THI KIM
Last Name:PHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3082 E BAYARD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-9701
Mailing Address - Country:US
Mailing Address - Phone:315-568-9033
Mailing Address - Fax:
Practice Address - Street 1:3082 E BAYARD STREET EXT
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-9701
Practice Address - Country:US
Practice Address - Phone:315-568-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily