Provider Demographics
NPI:1053021139
Name:PHAM, DOAN TRINH THUY (FNP-C)
Entity type:Individual
Prefix:
First Name:DOAN TRINH
Middle Name:THUY
Last Name:PHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12027 CHEVIOT DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2702
Mailing Address - Country:US
Mailing Address - Phone:703-725-0268
Mailing Address - Fax:
Practice Address - Street 1:12027 CHEVIOT DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-2702
Practice Address - Country:US
Practice Address - Phone:703-725-0268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF11220958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner