MEDICARE: MRS. BLAIR LYANNE CHANDLER FNP-C

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	363LF0000X	Family Nurse Practitioner	1047849	TX

General Provider Information

NPI Number	:	1871256156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BLAIR LYANNE CHANDLER FNP-C

Provider Business Mailing Address
First Line	:	7046 REDWOOD FALLS DR
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-4415
Country	:	US
Telephone Number	:	713-349-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 W SAN AUGUSTINE ST
Second Line	:
City	:	DEER PARK
State	:	TX
Zip	:	77536-4027
Country	:	US
Telephone Number	:	281-476-4616
Fax Number	:

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

Provider Enumeration Date	:	10/14/2021
Last Update Date	:	10/14/2021

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