Provider Demographics
NPI:1336973304
Name:VONG, PHEARY NA (LPN)
Entity type:Individual
Prefix:
First Name:PHEARY
Middle Name:NA
Last Name:VONG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E DUNSTABLE RD # NA
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-5863
Mailing Address - Country:US
Mailing Address - Phone:978-677-4217
Mailing Address - Fax:
Practice Address - Street 1:35 E DUNSTABLE RD # NA
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5863
Practice Address - Country:US
Practice Address - Phone:978-677-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN66137164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse