Provider Demographics
NPI:1073043907
Name:CHAFFEE, SUE ANN (PMHNP/DNP STUDENT)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANN
Last Name:CHAFFEE
Suffix:
Gender:F
Credentials:PMHNP/DNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 N CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351
Mailing Address - Country:US
Mailing Address - Phone:209-765-4692
Mailing Address - Fax:
Practice Address - Street 1:500 N 9TH ST STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5814
Practice Address - Country:US
Practice Address - Phone:209-341-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty