Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | APRN-2243 | HI |
Y | 363LW0102X | Nurse Practitioner - Women's Health | PENDING | HI |
NPI | 1063943173 |
---|---|
Provider Name | Tiffany Chance |
First Address | Apo, AP 96367-0038 |
Second Address | Apo, AP 96368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 17/10/2019 |