1033846316 NPI number — MRS. CHANTE PERRON BRITT PEER SPECIALIST

Table of content: MRS. CHANTE PERRON BRITT PEER SPECIALIST (NPI 1033846316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033846316 NPI number — MRS. CHANTE PERRON BRITT PEER SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRITT
Provider First Name:
CHANTE
Provider Middle Name:
PERRON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PEER SPECIALIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANSEN
Provider Other First Name:
CHANTE
Provider Other Middle Name:
PERRON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033846316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 N DEER MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82930-9004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-677-7498
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 CITY VIEW DR STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82930-5326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-789-7915
Provider Business Practice Location Address Fax Number:
307-789-6009
Provider Enumeration Date:
08/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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