Stacie Phan, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

348130 Issued in NY

Practice address

973 East Ave
Rochester, NY 14607-2216

Phone

(585) 244-1000

NPI assigned

Jan 7, 2017

Reactivated

Jul 12, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Interoperability endpoints

• Direct secure messaging: sschweickert@directaddress.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1538605050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 OXFORD ST",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146071507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "973 EAST AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146072216",
            "telephone_number": "585-244-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "STACIE",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-07",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "deactivation_date": "2020-02-14",
        "reactivation_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "NY",
            "license": "717751-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "348130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Pham
• Ngoc T Pham, NP
• Dangkhoa Phamdo, MD
• Amy Phan, MD
• Dennis Phan, MD
• Tramanh Xuan Phan, M.D.
• Katrina Marie Phanthourath
• Pharmhealth Infusion
• Ajinkya Vikram Phatak, M.D.
• Pradyumna Phatak, M.D.

• Family Nurse Practitioner in Rochester, NY
• Providers in Rochester, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.