Healthcare Provider Details

I. General information

NPI: 1598574451
Provider Name (Legal Business Name): ANNIE PAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE CHOU

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 E NORTHERN AVE
PHOENIX AZ
85020-4274
US

IV. Provider business mailing address

2762 W IVANHOE ST
CHANDLER AZ
85224-3434
US

V. Phone/Fax

Practice location:
  • Phone: 602-331-1470
  • Fax:
Mailing address:
  • Phone: 602-354-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number271006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: