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General NPI Number Information
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NPI Number | 1023384138
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Entity Type | Organization
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Legal Business Name | TEEN HEALTH CENTER, INC.
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 1514 AVENUE N 1/2 ROOM#172
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City | GALVESTON
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State | TX
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Zip | 77550-8135
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Country | US
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Telephone | 409-761-3516
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 925
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City | GALVESTON
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State | TX
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Zip | 77553-0925
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Country | US
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Telephone | 409-766-5750
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Fax | 409-750-9395
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SHEYANNE CHAN
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Credential | CPNP
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Telephone | 409-761-3517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 717639
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License Number State | TX
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