Provider Demographics
NPI:1487135190
Name:CHAN, BRENDA M (DNP, FNP, RN-BC)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:M
Last Name:CHAN
Suffix:
Gender:F
Credentials:DNP, FNP, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 SULTANA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1527
Mailing Address - Country:US
Mailing Address - Phone:626-236-8313
Mailing Address - Fax:
Practice Address - Street 1:6816 SULTANA AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-1527
Practice Address - Country:US
Practice Address - Phone:626-236-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9505363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner