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General NPI Number Information
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NPI Number | 1124175161
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Entity Type | Individual
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Provider Name | MARILYN MARIE CHAN EDD MSN MED APRN
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8925 SOUTH 2700 WEST
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City | WEST JORDAN
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State | UT
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Zip | 84044
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Country | US
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Telephone | 801-566-6200
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Fax | 801-566-7993
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Provider Business Mailing Address
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Address Line | 3451 S EASTWOOD DRIVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84109
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Country | US
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Telephone | 801-272-2682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 87-199449-4405
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License Number State | UT
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