Provider Demographics
NPI:1578786067
Name:CHITTENDEN, LUANNE (NONE)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:(NONE)
Last Name:CHITTENDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 UNSER WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:CA
Mailing Address - Zip Code:95684-9612
Mailing Address - Country:US
Mailing Address - Phone:530-620-5532
Mailing Address - Fax:530-622-1293
Practice Address - Street 1:344 PLACERVILLE DR
Practice Address - Street 2:SUITE 17
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3920
Practice Address - Country:US
Practice Address - Phone:530-621-6334
Practice Address - Fax:530-622-1293
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator