Provider Demographics
NPI:1801105705
Name:CHANDLER, JOHNNIE DIONNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOHNNIE
Middle Name:DIONNE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:2 EMBARCADERO CTR LBBY LEVEL
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3823
Practice Address - Country:US
Practice Address - Phone:415-578-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1830363A00000X
TXPA16296363A00000X
WAPA61276920363A00000X
ARP-T1014363AM0700X
CAPA21609363AM0700X
CA21609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA21609OtherCALIFORNIA LICENSE NUMBER
NV1801105705Medicaid
ARP-T1014OtherMEDICAL LICENSE