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General NPI Number Information
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NPI Number | 1932736121
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Entity Type | Individual
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Provider Name | CHAN LY
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 141 LILLY RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-5028
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Country | US
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Telephone | 360-413-8880
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Fax | 360-810-3697
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Provider Business Mailing Address
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Address Line | PO BOX 749495
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City | ATLANTA
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State | GA
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Zip | 30374-9495
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Country | US
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Telephone | 855-963-2100
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Fax | 813-321-1296
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | RN60240413
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61214320
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License Number State | WA
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