Provider Demographics
NPI:1528727153
Name:CHAISSON, WANDA MARY
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:MARY
Last Name:CHAISSON
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:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:JACKMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04945-0804
Mailing Address - Country:US
Mailing Address - Phone:207-668-7662
Mailing Address - Fax:
Practice Address - Street 1:303 MAIN STREET
Practice Address - Street 2:.
Practice Address - City:JACKMAN
Practice Address - State:ME
Practice Address - Zip Code:04945-0804
Practice Address - Country:US
Practice Address - Phone:207-668-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care