Healthcare Provider Details

I. General information

NPI: 1790175214
Provider Name (Legal Business Name): JOSEPHINE CHEN FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3052 WILLOW PASS RD
CONCORD CA
94519-2552
US

IV. Provider business mailing address

483 WICKSON AVE APT A
OAKLAND CA
94610-2766
US

V. Phone/Fax

Practice location:
  • Phone: 256-814-1009
  • Fax:
Mailing address:
  • Phone: 530-219-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number836079
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: