Provider Demographics
NPI:1003275843
Name:CHIARADONNA, CATHERINE (NP)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:CHIARADONNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 WILLIAMS HIGHWAY, SUITE 226
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:877-672-8620
Mailing Address - Fax:
Practice Address - Street 1:1867 WILLIAMS HWY STE 226
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5856
Practice Address - Country:US
Practice Address - Phone:877-672-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201405791363LA2200X
FL9191709363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health