Provider Demographics
NPI:1346235199
Name:CHEN, IFAN (ARNP)
Entity type:Individual
Prefix:
First Name:IFAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-1703
Mailing Address - Country:US
Mailing Address - Phone:402-494-3064
Mailing Address - Fax:712-294-7299
Practice Address - Street 1:501 1ST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-1703
Practice Address - Country:US
Practice Address - Phone:402-494-3064
Practice Address - Fax:712-294-7829
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160575OtherBC/BS ID NUMBER
KS44883OtherARNP LICENSE NUMBER
KS171815Medicare PIN
KS171813Medicare PIN
KS160575OtherBC/BS ID NUMBER
KS171814Medicare PIN
KS44883OtherARNP LICENSE NUMBER