Provider Demographics
NPI:1497330799
Name:WASHBURN, CHANDLER (PNP)
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557A DANNAHER DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-1509
Mailing Address - Country:US
Mailing Address - Phone:865-512-1180
Mailing Address - Fax:
Practice Address - Street 1:7557A DANNAHER DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-1509
Practice Address - Country:US
Practice Address - Phone:865-512-1180
Practice Address - Fax:865-512-1185
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN28362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics