1780244970 NPI number — CHASTITY RANAE FREDERICK FNP-C

Table of content: CHASTITY RANAE FREDERICK FNP-C (NPI 1780244970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780244970 NPI number — CHASTITY RANAE FREDERICK FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREDERICK
Provider First Name:
CHASTITY
Provider Middle Name:
RANAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUSS
Provider Other First Name:
CHASTITY
Provider Other Middle Name:
RANAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780244970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46122-1948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-745-4451
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL LN STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46122-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-456-9064
Provider Business Practice Location Address Fax Number:
317-386-5468
Provider Enumeration Date:
06/19/2019

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: 363LF0000X , with the licence number:  71009115A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com