Individual
HILDEGARD CHAN EPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.P.N.P
Contact information
Practice address
115 FERRIS PL, ITHACA, NY 14850-4525
(607) 319-5500
Mailing address
115 FERRIS PL, ITHACA, NY 14850-4525
(607) 319-5500
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F382095-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81904789
—
CO
Enumeration date
04/29/2006
Last updated
06/21/2012
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