Provider Demographics
NPI:1083817696
Name:LOBUE, CHANTAL MADELEINE (FNP/PAC)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:MADELEINE
Last Name:LOBUE
Suffix:
Gender:F
Credentials:FNP/PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3601
Mailing Address - Country:US
Mailing Address - Phone:707-839-4349
Mailing Address - Fax:707-839-4124
Practice Address - Street 1:1735 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3601
Practice Address - Country:US
Practice Address - Phone:707-839-4349
Practice Address - Fax:707-839-4124
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily