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NPI Code Detail

MEDICARE: SHAN CHISAM

MEDICARE: SHAN CHISAM
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1598264517
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAN CHISAM
Provider Business Mailing Address
First Line : 10300 HAWKS WING ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89178-3511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5115 SPRING MOUNTAIN RD STE 221
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-8720
Country : US
Telephone Number : 702-784-0888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2018
Last Update Date : 02/08/2018

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Directions to “ SHAN CHISAM ” Practice Location

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