Individual
NAM PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(214) 857-1817
Mailing address
4500 S LANCASTER RD # 112A, DALLAS, TX 75216-7167
(325) 433-9908
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
990535
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
1094719
TX
Other
Enumeration date
08/09/2022
Last updated
04/16/2024
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