Provider Demographics
NPI:1285886929
Name:HARDEN, CHANTIA BOBO (PA-C)
Entity type:Individual
Prefix:
First Name:CHANTIA
Middle Name:BOBO
Last Name:HARDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHANTIA
Other - Middle Name:
Other - Last Name:BOBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:130 TOWN CENTER DR
Mailing Address - Street 2:202
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8250
Mailing Address - Fax:248-585-8270
Practice Address - Street 1:44201 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005241363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant