Provider Demographics
NPI:1851116586
Name:GAITHER, CHANBRAY (RN, FNP)
Entity type:Individual
Prefix:
First Name:CHANBRAY
Middle Name:
Last Name:GAITHER
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:CHANBRAY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2475 MOON DUST DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4330
Mailing Address - Country:US
Mailing Address - Phone:909-521-8109
Mailing Address - Fax:
Practice Address - Street 1:1477 S MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2905
Practice Address - Country:US
Practice Address - Phone:714-782-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95190928163WM0705X
CA95033083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical