Provider Demographics
NPI:1861259038
Name:CHANG, ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4324
Mailing Address - Country:US
Mailing Address - Phone:603-393-2379
Mailing Address - Fax:
Practice Address - Street 1:145 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1235
Practice Address - Country:US
Practice Address - Phone:603-626-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056593-23207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine