Individual
MRS. JESSICA LYN CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
74 GROVE ST, NEW LONDON, CT 06320-6515
(860) 447-6070
(860) 443-6616
Mailing address
999 FOXON ROAD, SUITE 36, NORTH BRANFORD, CT 06471
(203) 484-7334
(203) 484-7301
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
94495
CT
363LP0200X
Pediatric Nurse Practitioner
Primary
5804
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008054046
—
CT
Enumeration date
06/18/2014
Last updated
09/10/2018
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