Provider Demographics
NPI:1346065380
Name:CHISMAN, CHARNISE
Entity type:Individual
Prefix:
First Name:CHARNISE
Middle Name:
Last Name:CHISMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAJESTIC CT APT 301
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4069
Mailing Address - Country:US
Mailing Address - Phone:843-934-5907
Mailing Address - Fax:
Practice Address - Street 1:123 CANDLEWOOD WAY # A1
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3228
Practice Address - Country:US
Practice Address - Phone:843-934-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401165806251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care