MEDICARE: HAN-CHIN C HUANG 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
1	363LF0000X	Family Nurse Practitioner	AP3760	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972812626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAN-CHIN C HUANG FNP

Provider Business Mailing Address
First Line	:	2175 MIMOSA DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6793
Country	:	US
Telephone Number	:	928-846-0290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 E WAGON WHEEL LN
Second Line	:	SUITE 110
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6697
Country	:	US
Telephone Number	:	928-788-3333
Fax Number	:	928-788-3555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	01/27/2016

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