Individual
MANDA LOUISE CHATELAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1331 N 7TH ST STE 405, PHOENIX, AZ 85006-2754
(602) 254-3151
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(866) 974-2673
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
AP1568
AZ
363LA2100X
Acute Care Nurse Practitioner
Primary
AP1568
AZ
363LF0000X
Family Nurse Practitioner
AP1568
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
188316200
DEPT OF LABOR ID
AZ
01
—
1Z9797
HEALTHNET
AZ
05
—
751679
—
AZ
01
—
860224285
TAX ID
AZ
01
—
AZ0143190
BC BS ID
AZ
01
—
CD4863
RAILROAD MEDICARE ID
AZ
Enumeration date
07/21/2006
Last updated
02/13/2024
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