MEDICARE: MS. WEIYI PAN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	341448	NY

General Provider Information

NPI Number	:	1639606544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WEIYI PAN FNP

Provider Business Mailing Address
First Line	:	2585 E 21ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2918
Country	:	US
Telephone Number	:	347-251-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	7105 3RD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1308
Country	:	US
Telephone Number	:	347-251-8830
Fax Number	:	347-251-8830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	08/22/2017

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