Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 95006985 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95006985 | CA |
NPI | 1073037610 |
---|---|
Provider Name | Erica Chang |
First Address | Lafayette, CA 94549-3746 |
Second Address | Oakland, CA 94609-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2017 |
Last Update Date | 26/07/2017 |