Provider Demographics
NPI:1598169815
Name:RICHARD, CHU JUN (DNP)
Entity type:Individual
Prefix:DR
First Name:CHU JUN
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 OAK HARBOR BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8862
Mailing Address - Country:US
Mailing Address - Phone:985-774-8091
Mailing Address - Fax:504-226-0751
Practice Address - Street 1:620 OAK HARBOR BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8862
Practice Address - Country:US
Practice Address - Phone:985-774-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7282363LA2200X
LAAP08462363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ980049Medicaid