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NPI Code Detail

MEDICARE: LI CHANG FNP

MEDICARE:   LI  CHANG  FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner200250164NPOR

General Provider Information

NPI Number : 1376627968
Entity Type Code : Individual
Provider Name (Legal Business Name) : LI CHANG FNP
Provider Business Mailing Address
First Line : 2050 PROGRESS WAY
Second Line :
City : WOODBURN
State : OR
Zip : 97071-9764
Country : US
Telephone Number : 503-981-5348
Fax Number : 503-981-0423
Provider Business Practice Location Address
First Line : 2050 PROGRESS WAY
Second Line :
City : WOODBURN
State : OR
Zip : 97071-9764
Country : US
Telephone Number : 503-981-5348
Fax Number : 503-981-0423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 09/11/2015

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Directions to “ LI CHANG FNP” Practice Location

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