Healthcare Provider Details

I. General information

NPI: 1588792378
Provider Name (Legal Business Name): KANDY LEIGH CHINTIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTH 1ST AVE
WHITERIVER AZ
85941
US

IV. Provider business mailing address

5339 BRANDING IRON LOOP
PINETOP AZ
85935-8534
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-4138
  • Fax: 928-338-6130
Mailing address:
  • Phone: 928-338-4138
  • Fax: 928-338-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN026274
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: