Healthcare Provider Details

I. General information

NPI: 1124704812
Provider Name (Legal Business Name): CHANDLIE STRATTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 E SHEA BLVD
SCOTTSDALE AZ
85260-6709
US

IV. Provider business mailing address

9810 OSUNA RD NE
ALBUQUERQUE NM
87111-2265
US

V. Phone/Fax

Practice location:
  • Phone: 435-773-2471
  • Fax:
Mailing address:
  • Phone: 435-773-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: