Provider Demographics
NPI:1124779327
Name:BIRDOW, CHASITY L (LPN)
Entity type:Individual
Prefix:MRS
First Name:CHASITY
Middle Name:L
Last Name:BIRDOW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHASITY
Other - Middle Name:L
Other - Last Name:BIRDOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5128 COUNTY ROAD 25
Mailing Address - Street 2:
Mailing Address - City:MINTER CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38944-2602
Mailing Address - Country:US
Mailing Address - Phone:662-392-4891
Mailing Address - Fax:
Practice Address - Street 1:5128 COUNTY ROAD 25
Practice Address - Street 2:
Practice Address - City:MINTER CITY
Practice Address - State:MS
Practice Address - Zip Code:38944-2602
Practice Address - Country:US
Practice Address - Phone:662-392-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS334636164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse