Provider Demographics
NPI:1336737121
Name:CHANG, FELICE ELIZABETH (MSN RN AGCNS-BC)
Entity type:Individual
Prefix:MS
First Name:FELICE
Middle Name:ELIZABETH
Last Name:CHANG
Suffix:
Gender:F
Credentials:MSN RN AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 JULI LYNN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5312
Mailing Address - Country:US
Mailing Address - Phone:408-425-5952
Mailing Address - Fax:
Practice Address - Street 1:4951 ARROYO RD BLDG 90
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9650
Practice Address - Country:US
Practice Address - Phone:925-373-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA812711163W00000X, 163WH1000X, 163WP0000X
CA4883364SL0600X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care