Healthcare Provider Details

I. General information

NPI: 1659866416
Provider Name (Legal Business Name): LILLIAN WEI CHANG PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 N 3RD ST
PHOENIX AZ
85004-1106
US

IV. Provider business mailing address

13555 W MCDOWELL RD STE 205
GOODYEAR AZ
85395-2626
US

V. Phone/Fax

Practice location:
  • Phone: 602-808-2800
  • Fax: 602-808-2799
Mailing address:
  • Phone: 623-295-1190
  • Fax: 602-429-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP11303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: