Provider Demographics
NPI:1972254746
Name:PHAM, LAN HOANG (RN)
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:HOANG
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 1:612 BROADHEAD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-2866
Mailing Address - Country:US
Mailing Address - Phone:717-419-2879
Mailing Address - Fax:
Practice Address - Street 1:3500 VICTORIA STREET VICTORIA BUILDING 360A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-0001
Practice Address - Country:US
Practice Address - Phone:888-747-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN709272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse