Chanda Brock LPN

NPI 1598050924 - Licensed Practical Nurse - 164W00000X

NPI Details
NPI 1598050924
Gender Female
Enumeration Date 06/14/2011
Last Updated 06/14/2011
Entity Type Individual
Active Over 5 years ago
Practice Location
10 EDWARDS DR APT 5
SWANSEA IL, 62226-8204, US
Phone (618) 570-1401
Fax
Business Location
10 EDWARDS DR APT 5
SWANSEA IL, 62226-8204, US
Phone (618) 570-1401
Fax
Toxanomy
Taxonomy Code 164W00000X
License State Missouri
License Number 2005009072
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According to our database, Chanda Brock LPN NPI is 1598050924, taxonomy code is 164W00000X and license number is 2005009072, license state is located at Missouri. Chanda Brock LPN physically located at 10 Edwards Dr Apt 5, Swansea IL, 62226-8204. NPI Number Chanda Brock LPN has the Individual type.

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1598050924 NPI number is provided on an as is basis without warranty of any kind. 1598050924 is maintained by the National Plan & Provider Enumeration System. The contents of Chanda Brock LPN are for informational purposes only.