Provider Demographics
NPI:1467185801
Name:GARRETT, CHANDLER (RN)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 EMPIS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6007
Mailing Address - Country:US
Mailing Address - Phone:310-990-2967
Mailing Address - Fax:
Practice Address - Street 1:6330 SAN VICENTE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5462
Practice Address - Country:US
Practice Address - Phone:310-855-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95220748163WR1000X, 163WW0101X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WR1000XNursing Service ProvidersRegistered NurseReproductive Endocrinology/Infertility
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory