MEDICARE: STEPHANIE MICHELLE CHALK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider

General Provider Information

NPI Number	:	1306630660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MICHELLE CHALK

Provider Business Mailing Address
First Line	:	2918 N 3RD ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68521-2948
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2918 N 3RD ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68521-2948
Country	:	US
Telephone Number	:	531-350-8361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2025
Last Update Date	:	04/09/2025

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Directions to “ STEPHANIE MICHELLE CHALK ” Practice Location

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