Provider Demographics
NPI:1912027509
Name:PHAM, KIEUANH T (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIEUANH
Middle Name:T
Last Name:PHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KIEUANH
Other - Middle Name:T
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:7734 W MCRAE WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5917
Mailing Address - Country:US
Mailing Address - Phone:623-215-4804
Mailing Address - Fax:
Practice Address - Street 1:20012 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-2204
Practice Address - Country:US
Practice Address - Phone:623-445-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN129491163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health