Provider Demographics
NPI:1356089015
Name:MILADINOVIC, CHANTEL MARIE
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:MARIE
Last Name:MILADINOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 W JOHN CABOT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7709
Mailing Address - Country:US
Mailing Address - Phone:623-428-4497
Mailing Address - Fax:
Practice Address - Street 1:9224 W JOHN CABOT RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7709
Practice Address - Country:US
Practice Address - Phone:623-428-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN166058163W00000X, 163WC1600X, 163WG0600X, 163WI0500X, 163WW0000X, 251E00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No251E00000XAgenciesHome Health