Provider Demographics
NPI:1013757822
Name:PHAM, LILY HOANG (FNP-C)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:HOANG
Last Name:PHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 S DUNKIRK ST UNIT 205
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-3279
Mailing Address - Country:US
Mailing Address - Phone:714-348-4878
Mailing Address - Fax:
Practice Address - Street 1:1831 S DUNKIRK ST UNIT 205
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-3279
Practice Address - Country:US
Practice Address - Phone:714-348-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty