Provider Demographics
NPI:1831492206
Name:STEPHAN, VY NGO (FNP)
Entity Type:Individual
Prefix:
First Name:VY
Middle Name:NGO
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VY
Other - Middle Name:TRINH
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:9520 W PALM LANE
Mailing Address - Street 2:STE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:623-556-8860
Mailing Address - Fax:623-876-9559
Practice Address - Street 1:7725 N 43RD AVE
Practice Address - Street 2:STE 510
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:877-809-5092
Practice Address - Fax:480-491-6239
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ606437Medicaid