Provider Demographics
NPI:1477167179
Name:CHAN, STEPHEN ANDREW (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANDREW
Last Name:CHAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N BEAUREGARD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1732
Mailing Address - Country:US
Mailing Address - Phone:703-717-4148
Mailing Address - Fax:703-717-4149
Practice Address - Street 1:1600 N BEAUREGARD ST STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1732
Practice Address - Country:US
Practice Address - Phone:703-717-4148
Practice Address - Fax:703-717-4149
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001262121163WE0003X
VA0024179973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency