Healthcare Provider Details

I. General information

NPI: 1609694777
Provider Name (Legal Business Name): MIKIKO CHASIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6541 ROLLING BROOK RD APT 105-11
ROANOKE VA
24019-1452
US

IV. Provider business mailing address

112 SPARKS DR
FOREST CITY NC
28043-9021
US

V. Phone/Fax

Practice location:
  • Phone: 828-351-6000
  • Fax: 828-287-7436
Mailing address:
  • Phone: 828-351-6000
  • Fax: 828-287-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185955
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: