Healthcare Provider Details

I. General information

NPI: 1649231655
Provider Name (Legal Business Name): CYNTHIA DIANNE CHAMNESS LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 KNOB HILL RD
AZLE TX
76020-6812
US

IV. Provider business mailing address

4414 KNOB HILL RD
AZLE TX
76020-6812
US

V. Phone/Fax

Practice location:
  • Phone: 817-444-8121
  • Fax: 817-444-8121
Mailing address:
  • Phone: 817-444-8121
  • Fax: 817-444-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number164996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: