Provider Demographics
NPI:1457921801
Name:CHANEY, STORMY SKY
Entity Type:Individual
Prefix:
First Name:STORMY
Middle Name:SKY
Last Name:CHANEY
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 1:403 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:RISINGSUN
Mailing Address - State:OH
Mailing Address - Zip Code:43457-9779
Mailing Address - Country:US
Mailing Address - Phone:419-494-9160
Mailing Address - Fax:
Practice Address - Street 1:403 N COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:RISINGSUN
Practice Address - State:OH
Practice Address - Zip Code:43457-9779
Practice Address - Country:US
Practice Address - Phone:419-494-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide