Healthcare Provider Details

I. General information

NPI: 1861977951
Provider Name (Legal Business Name): TERRI ANNETTE CHANDLER RN BSN CWON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRI PATTERSON RN BSN CWON

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 DUTCHMANS LN STE 1D
LOUISVILLE KY
40207-4741
US

IV. Provider business mailing address

3999 DUTCHMANS LN STE 1D
LOUISVILLE KY
40207-4741
US

V. Phone/Fax

Practice location:
  • Phone: 502-559-1860
  • Fax: 502-599-1867
Mailing address:
  • Phone: 502-559-1860
  • Fax: 502-559-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number1056796
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number1056796
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: