Healthcare Provider Details

I. General information

NPI: 1699447714
Provider Name (Legal Business Name): JIANWEI CHANG DILLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JIANWEI CHANG NP

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAGLE CREST DR
RANGELY CO
81648-2104
US

IV. Provider business mailing address

225 EAGLE CREST DR
RANGELY CO
81648-3105
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-5011
  • Fax:
Mailing address:
  • Phone: 970-675-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0996972-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: