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General NPI Number Information
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NPI Number | 1124482906
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Entity Type | Individual
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Provider Name | STEPHANIE RENEE CHANCY AGNP
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Gender | Female
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 2301 ERWIN RD
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City | DURHAM
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State | NC
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Zip | 27705-4699
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Country | US
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Telephone | 919-385-8941
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Fax | 919-385-1478
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Provider Business Mailing Address
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Address Line | 5412 LOWER CREEK CT
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City | APEX
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State | NC
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Zip | 27539-8364
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Country | US
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Telephone | 919-418-4401
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Fax | 919-385-1478
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | CHAN-CXPG07
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License Number State | NC
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