Provider Demographics
NPI:1104225200
Name:CHATTER, CHENOA
Entity type:Individual
Prefix:
First Name:CHENOA
Middle Name:
Last Name:CHATTER
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 1:3732 W ECHO LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-4772
Mailing Address - Country:US
Mailing Address - Phone:928-814-6402
Mailing Address - Fax:
Practice Address - Street 1:3732 W ECHO LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-4772
Practice Address - Country:US
Practice Address - Phone:928-814-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ374700000X374700000X
AZ376K00000X376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374700000XNursing Service Related ProvidersTechnician