NPI 1174937114 · live from the CMS NPI Registry
Jessica Lyn Chan, APRN
Nurse Practitioner, Pediatrics in New London, CT. National Provider Identifier 1174937114, active.
NPI record
| NPI | 1174937114 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 74 Grove St, New London, CT 06320 |
| Practice phone | 860-447-6070 |
| Mailing address | 999 Foxon Road, Suite 36, North Branford, CT 06471 |
| Enumerated | June 18, 2014 |
| Last updated | September 10, 2018 |
| Sole proprietor | Yes |
| Other names | Jessica Davis |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 5804 (CT) |
| Registered Nurse, Pediatrics | 163WP0200X | 94495 (CT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.