Provider Demographics
NPI:1912370362
Name:BARTLETT, CHANDRA (RN)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14113 EZRA LN
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-3018
Mailing Address - Country:US
Mailing Address - Phone:858-229-2547
Mailing Address - Fax:
Practice Address - Street 1:14113 EZRA LN
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-3018
Practice Address - Country:US
Practice Address - Phone:858-229-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA709835163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse