Provider Demographics
NPI:1992404818
Name:RAY, CHANTELLE
Entity type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:
Last Name:RAY
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 1:2215 STEWART AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-4041
Mailing Address - Country:US
Mailing Address - Phone:725-236-0024
Mailing Address - Fax:
Practice Address - Street 1:2215 STEWART AVE APT B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-4041
Practice Address - Country:US
Practice Address - Phone:725-236-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker