Healthcare Provider Details

I. General information

NPI: 1568196020
Provider Name (Legal Business Name): CHEN PETER CHOU FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 PETERS CREEK RD STE 110
ROANOKE VA
24019-4060
US

IV. Provider business mailing address

107 COMMUNITY WAY APT 332
STAUNTON VA
24401-4989
US

V. Phone/Fax

Practice location:
  • Phone: 800-765-7130
  • Fax:
Mailing address:
  • Phone: 540-255-1428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024184665
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: