=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811605678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOTUS FAMILY CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2022
-----------------------------------------------------
Last Update Date | 07/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 W WARNER RD STE 3
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85224-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-617-8390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 W WARNER RD STE 3
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85224-2634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-617-8390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TYANNE TUYEN VAN
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 602-617-8390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------