Healthcare Provider Details

I. General information

NPI: 1649942426
Provider Name (Legal Business Name): PRESLEY JEWEL CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRESLEY JEWEL WINDERS

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 S WASHINGTON ST
GRAND FORKS ND
58201
US

IV. Provider business mailing address

851 UNIVERSITY AVE APT 216
GRAND FORKS ND
58203-3566
US

V. Phone/Fax

Practice location:
  • Phone: 701-757-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: