Provider Demographics
NPI:1245310127
Name:CHANEY, NAOMI L (MD,)
Entity type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:L
Last Name:CHANEY
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 CHAPMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104
Mailing Address - Country:US
Mailing Address - Phone:702-378-2882
Mailing Address - Fax:702-319-5901
Practice Address - Street 1:5380 S. RAINBOW BLVD.
Practice Address - Street 2:#218
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-319-5900
Practice Address - Fax:702-319-5901
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV509160OtherSUMMERLIN LIFE
NV00140241OtherRAILROAD MEDICARE
NV509160OtherHMA
NVAA56264OtherHPHC
NVH98532Medicare UPIN
NVV38332Medicare ID - Type Unspecified