Basic Information
| Provider Information | |||||||||
| NPI: | 1972123743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 N CAMPBELL AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857191563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208383540 | ||||||||
| FaxNumber: | 5203253540 | ||||||||
| Practice Location | |||||||||
| Address1: | 1238 W ORANGE GROVE RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857042950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202979060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2020 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 240415 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.