Provider Demographics
NPI:1770099665
Name:FERRANTE, CHANEL CHRISTINE
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:CHRISTINE
Last Name:FERRANTE
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 1:23661 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4825
Mailing Address - Country:US
Mailing Address - Phone:310-456-1603
Mailing Address - Fax:310-456-5697
Practice Address - Street 1:23661 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4825
Practice Address - Country:US
Practice Address - Phone:310-456-1603
Practice Address - Fax:310-456-5697
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007297363LA2200X, 363LG0600X, 363LX0106X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Multi-Specialty