Healthcare Provider Details

I. General information

NPI: 1194792408
Provider Name (Legal Business Name): CHHAN D TOUCH RNCS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 JACKSON ST LOWELL COMMUNITY HEALTH CENTER
LOWELL MA
01852
US

IV. Provider business mailing address

585-597 MERRIMACK ST LOWELL COMMUNITY HEALTH CENTER
LOWELL MA
01854
US

V. Phone/Fax

Practice location:
  • Phone: 978-454-7685
  • Fax: 978-454-1681
Mailing address:
  • Phone: 978-454-7685
  • Fax: 978-454-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: