Provider Demographics
NPI:1851177240
Name:GRITTERS, CHANDA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:NICOLE
Last Name:GRITTERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-351-6852
Mailing Address - Fax:319-351-2625
Practice Address - Street 1:269 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-3645
Practice Address - Country:US
Practice Address - Phone:319-351-6852
Practice Address - Fax:319-351-2625
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant