Provider Demographics
NPI:1740711084
Name:PHAM, CARLA (CNP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3838 MASSILLON RD STE 360
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7965
Mailing Address - Country:US
Mailing Address - Phone:330-896-9625
Mailing Address - Fax:330-896-9768
Practice Address - Street 1:3838 MASSILLON RD STE 360
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7965
Practice Address - Country:US
Practice Address - Phone:330-896-9625
Practice Address - Fax:330-896-9768
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily