Healthcare Provider Details

I. General information

NPI: 1053247981
Provider Name (Legal Business Name): MRS. TINA LEE CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 OVERTHRUST RD
EVANSTON WY
82930-9260
US

IV. Provider business mailing address

PO BOX 2910
EVANSTON WY
82931-2910
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-4224
  • Fax:
Mailing address:
  • Phone: 307-789-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: