Provider Demographics
NPI:1508907197
Name:CHASE, JO ANNE (RD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANNE
Last Name:CHASE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ANNE
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:12237 GABOR WAY
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-8517
Mailing Address - Country:US
Mailing Address - Phone:559-645-0733
Mailing Address - Fax:
Practice Address - Street 1:20 N DEWITT AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0311
Practice Address - Country:US
Practice Address - Phone:559-299-2578
Practice Address - Fax:559-299-0245
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARD619370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ06163Medicare UPIN
CAZZZ27968ZMedicare ID - Type Unspecified