Provider Demographics
NPI:1043801863
Name:CHAN, OLIVIA JOYCE (NP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JOYCE
Last Name:CHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SANSOME ST STE 502
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3221
Mailing Address - Country:US
Mailing Address - Phone:415-205-0562
Mailing Address - Fax:
Practice Address - Street 1:500 SANSOME ST STE 502
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3221
Practice Address - Country:US
Practice Address - Phone:415-205-0562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95142318163W00000X
CA95024127363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse