Provider Demographics
NPI:1780875864
Name:PENNSYLVANIA
Entity type:Organization
Organization Name:PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM-KHUE
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-724-4330
Mailing Address - Street 1:108 SHALLOW SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-3004
Mailing Address - Country:US
Mailing Address - Phone:610-724-4330
Mailing Address - Fax:
Practice Address - Street 1:108 SHALLOW SPRINGS CT
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-3004
Practice Address - Country:US
Practice Address - Phone:610-724-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006119B282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access