Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 7693456-4405 | UT |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60838859 | WA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 7693456-8900 | UT |
NPI | 1043663446 |
---|---|
Provider Name | Thomas Chan |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Bellevue, WA 98007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2016 |
Last Update Date | 07/08/2018 |