Provider Demographics
NPI:1699447714
Name:CHANG DILLON, JIANWEI
Entity type:Individual
Prefix:
First Name:JIANWEI
Middle Name:
Last Name:CHANG DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JIANWEI
Other - Middle Name:
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:225 EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-3105
Mailing Address - Country:US
Mailing Address - Phone:970-675-2237
Mailing Address - Fax:
Practice Address - Street 1:225 EAGLE CREST DR
Practice Address - Street 2:
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648-2104
Practice Address - Country:US
Practice Address - Phone:970-675-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996972-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily