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General NPI Number Information
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NPI Number | 1346065380
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Entity Type | Individual
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Provider Name | CHARNISE CHISMAN
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Gender | Female
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 123 CANDLEWOOD WAY # A1
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3228
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Country | US
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Telephone | 843-934-5907
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MAJESTIC CT APT 301
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4069
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Country | US
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Telephone | 843-934-5907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 1401165806
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License Number State | VA
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