Provider Demographics
NPI:1760486161
Name:CHANEY, SALLY TRABERT (FNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:TRABERT
Last Name:CHANEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:CHANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1901 VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0412
Mailing Address - Country:US
Mailing Address - Phone:530-221-0194
Mailing Address - Fax:530-221-7845
Practice Address - Street 1:1901 VICTOR AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0412
Practice Address - Country:US
Practice Address - Phone:530-221-0194
Practice Address - Fax:530-221-7845
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABE477OtherPTAN
S38046Medicare UPIN
CA00G611320Medicare PIN
CAZZZ23426ZMedicare ID - Type UnspecifiedMEDICARE NUMBER