Healthcare Provider Details

I. General information

NPI: 1477280030
Provider Name (Legal Business Name): STEPHANIE CHAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 YGNACIO VALLEY RD STE 150
WALNUT CREEK CA
94598-2954
US

IV. Provider business mailing address

2278 HANFORD DR
SAN DIEGO CA
92111-6240
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-7340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95033145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: