Provider Demographics
NPI:1801312764
Name:BARNES, CHANDRA Y
Entity type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:Y
Last Name:BARNES
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 1:7115 NORTH AVE # 317
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7115 NORTH AVE
Practice Address - Street 2:#317
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304
Practice Address - Country:US
Practice Address - Phone:312-880-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILB652-1197-8885172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver