Provider Demographics
NPI:1376627968
Name:CHANG, LI (FNP)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 PROGRESS WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9764
Mailing Address - Country:US
Mailing Address - Phone:503-981-5348
Mailing Address - Fax:503-981-0423
Practice Address - Street 1:2050 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9764
Practice Address - Country:US
Practice Address - Phone:503-981-5348
Practice Address - Fax:503-981-0423
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250164NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily