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General NPI Number Information
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NPI Number | 1356947550
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Entity Type | Individual
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Provider Name | SHANNON GRACE CHITTENDEN APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 115 E WILLIAMS FIELD RD STE 101
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City | GILBERT
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State | AZ
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Zip | 85295-5231
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Country | US
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Telephone | 480-270-8318
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Fax |
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Provider Business Mailing Address
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Address Line | 115 E WILLIAMS FIELD RD STE 101
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City | GILBERT
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State | AZ
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Zip | 85295-5231
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Country | US
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Telephone | 515-360-9127
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 235623
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License Number State | AZ
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