Individual
MS. CATHERINE CHANDAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3001 DOUGLAS BLVD STE 150, ROSEVILLE, CA 95661-3853
(916) 241-9844
(916) 241-9845
Mailing address
15 MARILLA CT, SACRAMENTO, CA 95835-2431
(916) 524-0368
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21878
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21878
NP
CA
01
—
606698
RN
CA
Enumeration date
10/09/2012
Last updated
12/30/2021
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