Provider Demographics
NPI:1932855038
Name:CHAN, THERESA ROSE (MSN, FNP-C, RN)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ROSE
Last Name:CHAN
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Gender:F
Credentials:MSN, FNP-C, RN
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Mailing Address - Street 1:100 OLD PALISADE RD APT 2111
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7020
Mailing Address - Country:US
Mailing Address - Phone:510-220-1797
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERFRONT PLZ STE 300
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-5412
Practice Address - Country:US
Practice Address - Phone:201-273-7047
Practice Address - Fax:855-998-4358
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2025-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJF02220735363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care