Provider Demographics
NPI:1104344472
Name:NERYS, CHALSEA JAYNE HICKS (EMT-B)
Entity type:Individual
Prefix:
First Name:CHALSEA
Middle Name:JAYNE HICKS
Last Name:NERYS
Suffix:
Gender:F
Credentials:EMT-B
Other - Prefix:
Other - First Name:CHALSEA
Other - Middle Name:JAYNE
Other - Last Name:ENGUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT-B
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-CLQ-C
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-CLQ-C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
E3115244146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
146N00000XOtherUS ARMY