=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578786067
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUANNE (NONE) CHITTENDEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 344 PLACERVILLE DR SUITE 17
-----------------------------------------------------
City | PLACERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95667-3920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-621-6334
-----------------------------------------------------
Fax | 530-622-1293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4040 UNSER WAY
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95684-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-620-5532
-----------------------------------------------------
Fax | 530-622-1293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------