Provider Demographics
NPI:1336572585
Name:PHAM, ANNA (NP)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:110 BROOK ST
Mailing Address - Street 2:110 BROOK ST
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-405-4345
Mailing Address - Fax:
Practice Address - Street 1:110 BROOK ST
Practice Address - Street 2:110 BROOK ST
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-3956
Practice Address - Country:US
Practice Address - Phone:508-405-4345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN243221163WC0200X, 363LA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology