Provider Demographics
NPI:1467063214
Name:CHUKLANSEV, GAYANA (FNP)
Entity Type:Individual
Prefix:
First Name:GAYANA
Middle Name:
Last Name:CHUKLANSEV
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 W CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4136
Mailing Address - Country:US
Mailing Address - Phone:626-337-6246
Mailing Address - Fax:
Practice Address - Street 1:818 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4136
Practice Address - Country:US
Practice Address - Phone:626-337-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF08200623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily