Provider Demographics
NPI:1053663757
Name:MOHAN, SATISH CHINTAMANI (FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:CHINTAMANI
Last Name:MOHAN
Suffix:
Gender:M
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 LONE PINE BLVD
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-9403
Mailing Address - Country:US
Mailing Address - Phone:541-296-7724
Mailing Address - Fax:
Practice Address - Street 1:551 LONE PINE BLVD
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-9403
Practice Address - Country:US
Practice Address - Phone:541-296-7724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY750168163W00000X
OR201901473RN163W00000X
WANT60451628175F00000X
CAND-547175F00000X
OR202107432NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No175F00000XOther Service ProvidersNaturopath