Healthcare Provider Details

I. General information

NPI: 1972812626
Provider Name (Legal Business Name): HAN-CHIN C HUANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E WAGON WHEEL LN SUITE 110
FORT MOHAVE AZ
86426-6697
US

IV. Provider business mailing address

2175 MIMOSA DR
LAKE HAVASU CITY AZ
86403-6793
US

V. Phone/Fax

Practice location:
  • Phone: 928-788-3333
  • Fax: 928-788-3555
Mailing address:
  • Phone: 928-846-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3760
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: