Provider Demographics
NPI:1821583576
Name:CHAN, REX (FNP)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 W MARCH LN STE 303
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2336
Mailing Address - Country:US
Mailing Address - Phone:209-464-3627
Mailing Address - Fax:209-464-3630
Practice Address - Street 1:8715 CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-7921
Practice Address - Country:US
Practice Address - Phone:916-245-8888
Practice Address - Fax:916-924-3386
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95009017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily