Provider Demographics
NPI:1770254054
Name:RUNNELS, CHANTEL (CD)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:CHANTEL
Other - Middle Name:
Other - Last Name:RUNNELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD
Mailing Address - Street 1:4826 GREGORY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4826 GREGORY RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3971
Practice Address - Country:US
Practice Address - Phone:407-496-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula