| Doctor Name: | MARILYN MARIE CHAN |
| NPI Number: | 1124175161 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | EDD MSN MED APRN |
| License Number: | 87-199449-4405 |
| Business Practice Address: | 8925 South 2700 West West Jordan, UT - 84044 |
| Business Phone Number: | 8015666200 |
| Business Fax Number: | 8015667993 |
| Mailing Address: | 3451 S Eastwood Drive, SALT LAKE CITY |
| State: | UT |
| Postal Code: | 84109 |
| Phone Number: | 8012722682 |
| Fax Number: | |
| NPI Enumeration Date: | 01/04/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 87-199449-4405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |