Healthcare Provider Details

I. General information

NPI: 1972846418
Provider Name (Legal Business Name): JEANNIE Y CHAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

789 PANORAMA DR
SAN FRANCISCO CA
94131-1126
US

V. Phone/Fax

Practice location:
  • Phone: 415-269-4000
  • Fax:
Mailing address:
  • Phone: 415-269-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number18703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: