Healthcare Provider Details

I. General information

NPI: 1013692979
Provider Name (Legal Business Name): CHANNA KHAN CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 UNION ST STE 402
LYNN MA
01901-1353
US

IV. Provider business mailing address

280 UNION ST STE 402
LYNN MA
01901-1353
US

V. Phone/Fax

Practice location:
  • Phone: 781-780-7755
  • Fax: 781-598-0243
Mailing address:
  • Phone: 781-780-7755
  • Fax: 781-598-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: