Provider Demographics
NPI:1306563218
Name:LONGSWORTH, CHANTEL NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:NICOLE
Last Name:LONGSWORTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 DAY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1194
Mailing Address - Country:US
Mailing Address - Phone:386-402-3889
Mailing Address - Fax:
Practice Address - Street 1:64 DAY ST APT 3
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1194
Practice Address - Country:US
Practice Address - Phone:386-402-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN99399164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse