Provider Demographics
NPI:1407037062
Name:PHAM, LOAN ANH THI (RN)
Entity type:Individual
Prefix:
First Name:LOAN ANH
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14180 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4452
Mailing Address - Country:US
Mailing Address - Phone:714-896-7811
Mailing Address - Fax:714-896-7808
Practice Address - Street 1:14180 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4452
Practice Address - Country:US
Practice Address - Phone:714-896-7811
Practice Address - Fax:714-896-7808
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN458159163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health