Provider Demographics
NPI:1063962082
Name:PHAM, PAUL (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19625 10TH PL S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2210
Mailing Address - Country:US
Mailing Address - Phone:425-260-4626
Mailing Address - Fax:
Practice Address - Street 1:18205 YEW WAY
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-5003
Practice Address - Country:US
Practice Address - Phone:206-660-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60527042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse