Provider Demographics
NPI:1366986028
Name:HA, MYLINH PHUONG (FNP-BC)
Entity type:Individual
Prefix:
First Name:MYLINH
Middle Name:PHUONG
Last Name:HA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BROADWAY
Mailing Address - Street 2:#1115
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4381
Mailing Address - Country:US
Mailing Address - Phone:212-227-3350
Mailing Address - Fax:
Practice Address - Street 1:150 BROADWAY
Practice Address - Street 2:#1115
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4381
Practice Address - Country:US
Practice Address - Phone:212-227-3350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612299-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily