Basic Information
| Provider Information | |||||||||
| NPI: | 1275615429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANDLER | ||||||||
| FirstName: | SOPHIA | ||||||||
| MiddleName: | BONNETIA | ||||||||
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| Credential: | ACNS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | MUNFORD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380586159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705598418 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1030 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381042127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015238990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 11/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | 0386613 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.