Provider Demographics
NPI:1013263367
Name:DUNCAN, CHANALEE CRESIDA (RN)
Entity type:Individual
Prefix:
First Name:CHANALEE
Middle Name:CRESIDA
Last Name:DUNCAN
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 1:613 NIMROD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1501
Mailing Address - Country:US
Mailing Address - Phone:631-418-5700
Mailing Address - Fax:
Practice Address - Street 1:613 NIMROD CT
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1501
Practice Address - Country:US
Practice Address - Phone:631-418-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY589700-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse