Provider Demographics
NPI:1346951894
Name:CHEN, KATTIE LYNN (NP)
Entity Type:Individual
Prefix:
First Name:KATTIE
Middle Name:LYNN
Last Name:CHEN
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 1:1461 ALICE ST APT 305
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-4040
Mailing Address - Country:US
Mailing Address - Phone:203-506-0284
Mailing Address - Fax:
Practice Address - Street 1:1162 MONTGOMERY DR STE 2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4802
Practice Address - Country:US
Practice Address - Phone:707-890-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023399363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty