Provider Demographics
NPI:1881957710
Name:CHANDLER, FONDA (RN)
Entity type:Individual
Prefix:
First Name:FONDA
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 1:1378 HIGHWAY 505
Mailing Address - Street 2:
Mailing Address - City:DODSON
Mailing Address - State:LA
Mailing Address - Zip Code:71422-3546
Mailing Address - Country:US
Mailing Address - Phone:318-628-3079
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2786
Practice Address - Country:US
Practice Address - Phone:318-628-2148
Practice Address - Fax:318-628-6822
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN041436163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health