Basic Information
| Provider Information | |||||||||
| NPI: | 1528380227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAN | ||||||||
| FirstName: | WEN-CHI | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1355 EAST ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960010801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306054260 | ||||||||
| FaxNumber: | 5306054260 | ||||||||
| Practice Location | |||||||||
| Address1: | 1355 EAST ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960010801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306054260 | ||||||||
| FaxNumber: | 5306054265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2010 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00174327 | WA | N | Nursing Service Providers | Registered Nurse | 363L00000X | AP60138157 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.