Healthcare Provider Details

I. General information

NPI: 1508997289
Provider Name (Legal Business Name): GERALDINE ANN CHANDLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

235 CHESTNUT ST
SPRINGFIELD MA
01103-1100
US

IV. Provider business mailing address

192 BRIMFIELD RD
MONSON MA
01057-9627
US

V. Phone/Fax

Practice location:
  • Phone: 413-726-0518
  • Fax:
Mailing address:
  • Phone: 413-267-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number189663
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: