Healthcare Provider Details

I. General information

NPI: 1265576185
Provider Name (Legal Business Name): CHANTAL ANNETTE-VAN HOUTEN MANHART ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E IL ROUTE 38
ROCHELLE IL
61068-9694
US

IV. Provider business mailing address

1675 BETHANY RD STE C
SYCAMORE IL
60178-3160
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-9050
  • Fax:
Mailing address:
  • Phone: 815-899-8080
  • Fax: 815-899-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277-001059
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-087782
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF-087782
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.006994
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: