Provider Demographics
NPI:1295446169
Name:CHACON, BRANDICE ELVIRA (LICENSED NURSE)
Entity type:Individual
Prefix:MISS
First Name:BRANDICE
Middle Name:ELVIRA
Last Name:CHACON
Suffix:
Gender:F
Credentials:LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-3260
Mailing Address - Country:US
Mailing Address - Phone:530-561-0857
Mailing Address - Fax:
Practice Address - Street 1:855 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3260
Practice Address - Country:US
Practice Address - Phone:530-561-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA682330164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse