Provider Demographics
NPI:1861246696
Name:CHANNA PITTMAN
Entity type:Organization
Organization Name:CHANNA PITTMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANNA
Authorized Official - Middle Name:ROXANNE
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-354-4228
Mailing Address - Street 1:817 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6651
Mailing Address - Country:US
Mailing Address - Phone:651-354-4228
Mailing Address - Fax:651-797-4413
Practice Address - Street 1:1115 GREENBRIER ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2540
Practice Address - Country:US
Practice Address - Phone:651-354-4228
Practice Address - Fax:651-797-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty