Healthcare Provider Details

I. General information

NPI: 1174771885
Provider Name (Legal Business Name): MAY L CHANG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 COLUMBIA ST STE 400
SEATTLE WA
98104-2053
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2090
  • Fax: 206-215-3099
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60035785
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60035785
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00168005
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberAP60035785
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: