Provider Demographics
NPI:1417839077
Name:CHANDLER, AUSTIN JEFFREY
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JEFFREY
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 ELMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1138
Mailing Address - Country:US
Mailing Address - Phone:951-990-6516
Mailing Address - Fax:
Practice Address - Street 1:4390 ELMWOOD CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1138
Practice Address - Country:US
Practice Address - Phone:951-990-6516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse