Provider Demographics
NPI:1902614142
Name:HART, CHIFFON T (LPN)
Entity type:Individual
Prefix:
First Name:CHIFFON
Middle Name:T
Last Name:HART
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 1:121 CRERAND CIR
Mailing Address - Street 2:
Mailing Address - City:GATES
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4370
Mailing Address - Country:US
Mailing Address - Phone:585-313-9378
Mailing Address - Fax:
Practice Address - Street 1:121 CRERAND CIR
Practice Address - Street 2:
Practice Address - City:GATES
Practice Address - State:NY
Practice Address - Zip Code:14606-4370
Practice Address - Country:US
Practice Address - Phone:585-313-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334307-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse