Healthcare Provider Details

I. General information

NPI: 1790060960
Provider Name (Legal Business Name): HELEN X QIAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E. LOCUST ST
LONE PINE CA
93545-0002
US

IV. Provider business mailing address

851 N CHESTER AVE
PASADENA CA
91104-2921
US

V. Phone/Fax

Practice location:
  • Phone: 760-876-1146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: