# THU PHAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1245779016
- **Gender:** F
- **Credential:** MSN, AGNP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WM0705X | Medical-Surgical Registered Nurse | 803544 | CA | — |
| 363LG0600X | Gerontology Nurse Practitioner | 95006018 | CA | Yes |

## Other

- **Enumeration date:** 02/14/2017
- **Last updated:** 02/14/2017