Provider Demographics
NPI:1568628808
Name:WOZNIAK, CHANDRA L (AA)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:L
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2316
Mailing Address - Country:US
Mailing Address - Phone:216-674-5230
Mailing Address - Fax:216-674-5231
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2316
Practice Address - Country:US
Practice Address - Phone:216-674-5230
Practice Address - Fax:216-674-5231
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005056367H00000X
OH67.000148367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant