Basic Information
| Provider Information | |||||||||
| NPI: | 1609342161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANCHOLA | ||||||||
| FirstName: | GUADALUPE | ||||||||
| MiddleName: | HAZEL | ||||||||
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| Credential: | CNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 6TH ST NE APT 8 | ||||||||
| Address2: | |||||||||
| City: | EAST WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988027605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092644331 | ||||||||
| FaxNumber: | 5096644868 | ||||||||
| Practice Location | |||||||||
| Address1: | 1230 MONITOR ST | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988013534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093001221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2018 | ||||||||
| LastUpdateDate: | 10/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | NC10015820 | WA | Y | Nursing Service Related Providers | Nurse's Aide |
No ID Information.