Healthcare Provider Details

I. General information

NPI: 1891168514
Provider Name (Legal Business Name): MATTHEW LOGAN CHATIGNY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-5178
  • Fax: 916-734-0980
Mailing address:
  • Phone: 916-703-5178
  • Fax: 916-734-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number641287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: