Provider Demographics
NPI:1730830373
Name:CHENNETTE, ANNE LOUISE (CNA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:LOUISE
Last Name:CHENNETTE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1566
Mailing Address - Country:US
Mailing Address - Phone:951-537-4283
Mailing Address - Fax:
Practice Address - Street 1:30 MAPLE DR
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-1566
Practice Address - Country:US
Practice Address - Phone:208-513-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDZF375580D172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty