Provider Demographics
NPI:1972069557
Name:HOUSE, CHANTEL (CRNP)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 FREEMAN FALLS RD
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:PA
Mailing Address - Zip Code:15610-2211
Mailing Address - Country:US
Mailing Address - Phone:719-426-0213
Mailing Address - Fax:
Practice Address - Street 1:203 E PATRIOT ST STE 100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2001
Practice Address - Country:US
Practice Address - Phone:855-502-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily