Individual
TIEN T PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN, CNP
Contact information
Practice address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 589-2050
(309) 692-4730
Mailing address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 589-2050
(309) 692-4730
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209017737
IL
Other
Enumeration date
10/15/2018
Last updated
05/07/2025
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