Provider Demographics
NPI:1295511038
Name:CHANDLER, TERESA MAGDALINA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MAGDALINA
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13560 US HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:WV
Mailing Address - Zip Code:26447-8237
Mailing Address - Country:US
Mailing Address - Phone:509-287-1184
Mailing Address - Fax:
Practice Address - Street 1:13560 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:WV
Practice Address - Zip Code:26447-8237
Practice Address - Country:US
Practice Address - Phone:509-287-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant