Chan, Jessica Lyn

Chan, Jessica Lyn is an sole proprietor health care provider with primary practice located at 74 Grove St , New London CT 06320-6515. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Nursing Service Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Chan, Jessica Lyn can be contacted via phone (860) 447-6070.

Contact Information

Primary practice address
74 Grove St New London CT 06320-6515
Phone: (860) 447-6070
Fax: (860) 443-6616
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 5804 Connecticut
Nursing Service Providers / Pediatrics 163WP0200X 94495 Connecticut

Profile Details

NPI number 1174937114
LBN Legal business name Chan, Jessica Lyn
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 18th, 2014
Last updated Sep 10th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174937114 NPPES
Connecticut MEDICAID 008054046

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