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General NPI Number Information
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NPI Number | 1861263477
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Entity Type | Individual
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Provider Name | CHICQUTAR SYMONETTE APRN
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Gender | Female
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 1027 JEFFERSONVILLE COMMONS DR
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-8395
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Country | US
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Telephone | 812-288-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 SHERMAN DR
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-5928
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Country | US
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Telephone | 502-797-5134
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71015232A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4008153
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License Number State | KY
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