Provider Demographics
NPI:1659260990
Name:WHITE, CHEVALLA LES (CNA/DCW)
Entity type:Individual
Prefix:MS
First Name:CHEVALLA
Middle Name:LES
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNA/DCW
Other - Prefix:
Other - First Name:CHEVALLA
Other - Middle Name:LES
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA/DCW
Mailing Address - Street 1:24409 LEHIGH ST # NA
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1942
Mailing Address - Country:US
Mailing Address - Phone:313-420-3933
Mailing Address - Fax:
Practice Address - Street 1:24409 LEHIGH ST # NA
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1942
Practice Address - Country:US
Practice Address - Phone:313-420-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230005499911101376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide