Provider Demographics
NPI:1154281970
Name:CHU, CONNIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23141 MOULTON PKWY
Mailing Address - Street 2:#102
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-916-9100
Mailing Address - Fax:949-916-0091
Practice Address - Street 1:23141 MOULTON PKWY
Practice Address - Street 2:#102
Practice Address - City:LAGUNA HILLS,
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-916-9100
Practice Address - Fax:949-916-0091
Is Sole Proprietor?:No
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily