Healthcare Provider Details

I. General information

NPI: 1871559161
Provider Name (Legal Business Name): M COLETTE CHANDLER PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 GOLDIE RD
OAK HARBOR WA
98277
US

IV. Provider business mailing address

1300 GOLDIE RD
OAK HARBOR WA
98277
US

V. Phone/Fax

Practice location:
  • Phone: 360-679-5590
  • Fax:
Mailing address:
  • Phone: 360-679-5590
  • Fax: 360-675-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberPA10003391
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: