Provider Demographics
NPI:1982310413
Name:CHESTER, JOHNNETTA M
Entity type:Individual
Prefix:MRS
First Name:JOHNNETTA
Middle Name:M
Last Name:CHESTER
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 1:298 FAIRWAY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5203
Mailing Address - Country:US
Mailing Address - Phone:702-955-8433
Mailing Address - Fax:
Practice Address - Street 1:530B HARKLE RD STE 100
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4739
Practice Address - Country:US
Practice Address - Phone:505-629-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician