Provider Demographics
NPI:1699798488
Name:CHIN, NANCY (PA-C)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2132
Mailing Address - Country:US
Mailing Address - Phone:203-288-2886
Mailing Address - Fax:203-288-2576
Practice Address - Street 1:280 STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2132
Practice Address - Country:US
Practice Address - Phone:203-288-2886
Practice Address - Fax:203-288-2576
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001084363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970001066Medicare ID - Type UnspecifiedMEDICARE
CTP61268Medicare UPIN