Provider Demographics
NPI:1528380227
Name:FAN, WEN-CHI (ARNP)
Entity Type:Individual
Prefix:
First Name:WEN-CHI
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 EAST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0801
Mailing Address - Country:US
Mailing Address - Phone:530-605-4260
Mailing Address - Fax:530-605-4260
Practice Address - Street 1:1355 EAST ST STE 200
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0801
Practice Address - Country:US
Practice Address - Phone:530-605-4260
Practice Address - Fax:530-605-4265
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00174327163W00000X
WAAP60138157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse