Provider Demographics
NPI:1487601795
Name:CHANDLER, SCOTT JUDE (CRNA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JUDE
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9133
Mailing Address - Country:US
Mailing Address - Phone:989-731-1277
Mailing Address - Fax:
Practice Address - Street 1:565 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9133
Practice Address - Country:US
Practice Address - Phone:989-731-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704167548367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4327488Medicaid
MI4327488Medicaid
MION4950Medicare PIN
MION4950Medicare PIN