Provider Demographics
NPI:1932770534
Name:LOWRY-WYATT, CHENEL DENISE (BSN RN)
Entity type:Individual
Prefix:
First Name:CHENEL
Middle Name:DENISE
Last Name:LOWRY-WYATT
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 SPRING VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-7062
Mailing Address - Country:US
Mailing Address - Phone:843-514-8028
Mailing Address - Fax:
Practice Address - Street 1:3328 SPRING VALLEY CT
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-7062
Practice Address - Country:US
Practice Address - Phone:843-514-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9518667163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse