Healthcare Provider Details

I. General information

NPI: 1306443460
Provider Name (Legal Business Name): ZHENGQI FAN DNP, APNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 W GREENFIELD AVE
WEST ALLIS WI
53214-4958
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-2561
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-8577
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10430
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: