Provider Demographics
NPI:1265239792
Name:CHANDLER, MARQUISHA A
Entity type:Individual
Prefix:
First Name:MARQUISHA
Middle Name:A
Last Name:CHANDLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9008 N 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-8400
Mailing Address - Country:US
Mailing Address - Phone:402-972-7824
Mailing Address - Fax:
Practice Address - Street 1:9008 N 156TH AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-8400
Practice Address - Country:US
Practice Address - Phone:402-972-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities