MEDICARE: MARIE CHANEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704271130	MI

General Provider Information

NPI Number	:	1720832454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE CHANEY

Provider Business Mailing Address
First Line	:	9731 COLUMBIA AVE
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-3107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9731 COLUMBIA AVE
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-3107
Country	:	US
Telephone Number	:	810-931-9971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	04/17/2024

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Directions to “ MARIE CHANEY ” Practice Location

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