=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821254038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANTAL E. TRICE CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2008
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 S WASHINGTON AVE
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-2768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-836-1862
-----------------------------------------------------
Fax | 724-689-0543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44 S WASHINGTON AVE
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601-2768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-836-1862
-----------------------------------------------------
Fax | 724-689-0543
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP009887
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------