Provider Demographics
NPI:1831604479
Name:SIU, CHIN PANG (CRNP)
Entity type:Individual
Prefix:MR
First Name:CHIN
Middle Name:PANG
Last Name:SIU
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7201 HAPPY HOLLOW ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173
Mailing Address - Country:US
Mailing Address - Phone:205-508-6235
Mailing Address - Fax:205-508-6237
Practice Address - Street 1:7201 HAPPY HOLLOW ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173
Practice Address - Country:US
Practice Address - Phone:205-508-6235
Practice Address - Fax:205-508-6237
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125274363LA2100X, 363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology