Provider Demographics
NPI:1053566505
Name:LE, PHUONG T (NP)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2330 S LAMAR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5265
Practice Address - Country:US
Practice Address - Phone:949-284-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107155363L00000X
AR212951363L00000X
COAPN0995685363L00000X
DCRN1059045363L00000X
NJ26NR22062200363L00000X
MDR246627363L00000X
AZ246648363L00000X
CA18647363L00000X
TX28000363L00000X
WAAP61094823363L00000X
MARN2350383363LF0000X
AL11839375-3102363LF0000X
CT3907363LF0000X
FL11007868363L00000X
IL209.021786363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner