Provider Demographics
NPI:1912393257
Name:CHAN, DORIS S (RN,FNP)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:S
Last Name:CHAN
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:MS
Other - First Name:DORIS
Other - Middle Name:S
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2516 E WILLOW ST UNIT 110
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-6327
Mailing Address - Country:US
Mailing Address - Phone:562-595-4011
Mailing Address - Fax:
Practice Address - Street 1:2516 E WILLOW ST UNIT 110
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-6327
Practice Address - Country:US
Practice Address - Phone:562-595-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN462249163WC0200X
CA11387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily