Healthcare Provider Details

I. General information

NPI: 1780134007
Provider Name (Legal Business Name): BRENDA CHANDLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 98 AND NAVAJO ROUTE 16
TONALEA AZ
86044
US

IV. Provider business mailing address

PO BOX 7397
SHONTO AZ
86054-7397
US

V. Phone/Fax

Practice location:
  • Phone: 928-672-3087
  • Fax:
Mailing address:
  • Phone: 928-672-3087
  • Fax: 928-372-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN172525
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: