Provider Demographics
NPI:1831915693
Name:XIONG, PA HOUA
Entity type:Individual
Prefix:
First Name:PA HOUA
Middle Name:
Last Name:XIONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-5511
Mailing Address - Country:US
Mailing Address - Phone:763-232-4311
Mailing Address - Fax:
Practice Address - Street 1:257 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-5511
Practice Address - Country:US
Practice Address - Phone:763-232-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IHCP-2273374U00000X
SCIHCP-2273374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide