Provider Demographics
NPI:1962529339
Name:CHAN, ALICE L (NP)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:L
Last Name:CHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE # 6M5
Mailing Address - Street 2:SFGH CHILDREN'S HEALTH CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-3609
Mailing Address - Fax:415-206-6900
Practice Address - Street 1:1001 POTRERO AVE # 6M5
Practice Address - Street 2:SFGH CHILDREN'S HEALTH CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-3609
Practice Address - Fax:415-206-6900
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN283520163WP0200X
CANPF3498363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0200XNursing Service ProvidersRegistered NursePediatrics
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
034488OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
034488OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER