Basic Information
| Provider Information | |||||||||
| NPI: | 1831492206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHAN | ||||||||
| FirstName: | VY | ||||||||
| MiddleName: | NGO | ||||||||
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| Credential: | FNP | ||||||||
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| OtherLastName: | NGO | ||||||||
| OtherFirstName: | VY | ||||||||
| OtherMiddleName: | TRINH | ||||||||
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| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9520 W PALM LANE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850374403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235568860 | ||||||||
| FaxNumber: | 6238769559 | ||||||||
| Practice Location | |||||||||
| Address1: | 7725 N 43RD AVE | ||||||||
| Address2: | STE 510 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778095092 | ||||||||
| FaxNumber: | 4804916239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2010 | ||||||||
| LastUpdateDate: | 06/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3857 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 606437 | 05 | AZ | MEDICAID |