Provider Demographics
NPI:1427390988
Name:BONDURANT, CHANTILEER (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CHANTILEER
Middle Name:
Last Name:BONDURANT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHANTILEER
Other - Middle Name:
Other - Last Name:MCNEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1230 S CEDAR CREST BLVD # 302304
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6367
Mailing Address - Country:US
Mailing Address - Phone:610-432-4529
Mailing Address - Fax:610-432-2206
Practice Address - Street 1:1230 S CEDAR CREST BLVD # 302304
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6367
Practice Address - Country:US
Practice Address - Phone:610-432-4529
Practice Address - Fax:610-432-2206
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016053363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner