Provider Demographics
NPI:1821824160
Name:CHAN, MA CHRISTINA (FNP-C)
Entity type:Individual
Prefix:
First Name:MA CHRISTINA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:7040 GRACE ESTATE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4725
Mailing Address - Country:US
Mailing Address - Phone:843-496-9295
Mailing Address - Fax:
Practice Address - Street 1:7040 GRACE ESTATE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4725
Practice Address - Country:US
Practice Address - Phone:843-496-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVF09240352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily