Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN224640 | GA |
NPI | 1013457845 |
---|---|
Provider Name | Phung Ngoc Lu |
First Address | Atlanta, GA 30308 |
Second Address | Atlanta, GA 30308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 27/02/2017 |