Provider Demographics
NPI:1295111912
Name:CHANO, MARJORIE (PA)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:CHANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 SW 160TH AVE
Mailing Address - Street 2:APT 112
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4658
Mailing Address - Country:US
Mailing Address - Phone:786-258-1345
Mailing Address - Fax:
Practice Address - Street 1:501 NW 179TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2807
Practice Address - Country:US
Practice Address - Phone:954-442-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108513363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical