Provider Demographics
NPI:1851032676
Name:CHAN, ANDREA DOROTHY (BSC, MACC, CFE)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DOROTHY
Last Name:CHAN
Suffix:
Gender:F
Credentials:BSC, MACC, CFE
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:DOROTHY
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7529 LINTWHITE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2458
Mailing Address - Country:US
Mailing Address - Phone:725-248-7592
Mailing Address - Fax:
Practice Address - Street 1:7529 LINTWHITE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2458
Practice Address - Country:US
Practice Address - Phone:725-248-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider