Provider Demographics
NPI:1992734875
Name:CHANT, DALE (CRNP)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:CHANT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MAIDEN CHOICE LN
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5968
Mailing Address - Country:US
Mailing Address - Phone:732-643-2070
Mailing Address - Fax:732-643-2015
Practice Address - Street 1:3000 ESSEX RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-2631
Practice Address - Country:US
Practice Address - Phone:732-643-2070
Practice Address - Fax:732-643-2015
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N007564700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7700300Medicaid
8304132OtherEVERCARE
522114204BOtherBCBS OF NJ
NJ7700300Medicaid
P00367198Medicare PIN
8304132OtherEVERCARE
P00448423Medicare PIN
S54201Medicare UPIN