Provider Demographics
NPI:1164651279
Name:CHAN, JACQUELINE YAN-NEI (PA - C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:YAN-NEI
Last Name:CHAN
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:FCO-4
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-672-2288
Mailing Address - Fax:612-672-2288
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:FCO-4
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-672-2288
Practice Address - Fax:612-672-2288
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2011-04-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant