Provider Demographics
NPI:1073732335
Name:CHANDLER, JUDITH ANN ELDRED (NP NURSE PRACTITIONE)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN ELDRED
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:NP NURSE PRACTITIONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1356
Mailing Address - Country:US
Mailing Address - Phone:719-473-2614
Mailing Address - Fax:
Practice Address - Street 1:3525 AMERICAN DRIVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917
Practice Address - Country:US
Practice Address - Phone:719-597-6075
Practice Address - Fax:719-573-6529
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105635363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08697Medicare UPIN