Provider Demographics
NPI:1497871248
Name:PRYOR, CHAVONNE SUZANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:CHAVONNE
Middle Name:SUZANNE
Last Name:PRYOR
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 1:17750 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-9868
Mailing Address - Country:US
Mailing Address - Phone:541-549-7445
Mailing Address - Fax:
Practice Address - Street 1:63360 NW BRITTA ST STE 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9475
Practice Address - Country:US
Practice Address - Phone:541-617-3328
Practice Address - Fax:541-388-7893
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health