Provider Demographics
NPI:1306359146
Name:ADDIS, CHALICE ANN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CHALICE
Middle Name:ANN
Last Name:ADDIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23181 VERDUGO DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1357
Mailing Address - Country:US
Mailing Address - Phone:949-366-1053
Mailing Address - Fax:949-916-7710
Practice Address - Street 1:141 SANDCASTLE
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3817
Practice Address - Country:US
Practice Address - Phone:949-637-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily