Provider Demographics
NPI:1780134007
Name:CHANDLER, BRENDA (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7397
Mailing Address - Street 2:
Mailing Address - City:SHONTO
Mailing Address - State:AZ
Mailing Address - Zip Code:86054-7397
Mailing Address - Country:US
Mailing Address - Phone:928-672-3087
Mailing Address - Fax:928-372-3062
Practice Address - Street 1:HIGHWAY 98 AND NAVAJO ROUTE 16
Practice Address - Street 2:
Practice Address - City:TONALEA
Practice Address - State:AZ
Practice Address - Zip Code:86044
Practice Address - Country:US
Practice Address - Phone:928-672-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN172525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse