Provider Demographics
NPI:1629535257
Name:CHANEY, CAROL ANN (FNP, PHD NUTRITION)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:CHANEY
Suffix:
Gender:F
Credentials:FNP, PHD NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 W SAHARA AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8828
Mailing Address - Country:US
Mailing Address - Phone:702-312-1101
Mailing Address - Fax:
Practice Address - Street 1:9330 W SAHARA AVE STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8828
Practice Address - Country:US
Practice Address - Phone:702-312-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV818242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily