Provider Demographics
NPI:1972898591
Name:CUNDIFF, CHASITY DAWN (LPN)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:DAWN
Last Name:CUNDIFF
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 1:2247 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3972
Mailing Address - Country:US
Mailing Address - Phone:513-403-3745
Mailing Address - Fax:
Practice Address - Street 1:2247 HUNT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3972
Practice Address - Country:US
Practice Address - Phone:513-403-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 126005164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse