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NPI Code Detail

MEDICARE: HOLLYANN CHAN CNP

MEDICARE: HOLLYANN CHAN CNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner11811MN

General Provider Information

NPI Number : 1619728250
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLYANN CHAN CNP
Provider Business Mailing Address
First Line : 810 E 4TH ST
Second Line :
City : DULUTH
State : MN
Zip : 55805-2147
Country : US
Telephone Number : 218-728-4491
Fax Number : 218-740-5310
Provider Business Practice Location Address
First Line : 4720 BURNING TREE RD
Second Line :
City : DULUTH
State : MN
Zip : 55811-2634
Country : US
Telephone Number : 218-740-5300
Fax Number : 218-740-5310
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2024
Last Update Date : 10/15/2025

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