Provider Demographics
NPI:1477573558
Name:CHEN, YAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:YAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6432 BANNOCKBURN DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5472
Mailing Address - Country:US
Mailing Address - Phone:301-229-3480
Mailing Address - Fax:301-229-3480
Practice Address - Street 1:3720 UPTON ST, NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2299
Practice Address - Country:US
Practice Address - Phone:202-966-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN964169363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS64015Medicare UPIN
DC490737Medicare ID - Type UnspecifiedMEDICARE NUMBER