Provider Demographics
NPI:1104923150
Name:PHAM, ANNETTE VAN ANH (NP)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:VAN ANH
Last Name:PHAM
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Gender:F
Credentials:NP
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Mailing Address - Street 1:14445 OLIVE VIEW DR
Mailing Address - Street 2:ROOM 2B182
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1437
Mailing Address - Country:US
Mailing Address - Phone:818-364-4569
Mailing Address - Fax:818-364-3625
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:ROOM 2B182
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:818-364-4568
Practice Address - Fax:818-364-3625
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-12
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Provider Licenses
StateLicense IDTaxonomies
CA535887163W00000X
CA12756363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse