Provider Demographics
NPI:1982919551
Name:CHESS, TINA ELIZABETH (LPN)
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:ELIZABETH
Last Name:CHESS
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 1:102 WILDHERD DR
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9770
Mailing Address - Country:US
Mailing Address - Phone:585-820-7097
Mailing Address - Fax:
Practice Address - Street 1:102 WILDHERD DR
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9770
Practice Address - Country:US
Practice Address - Phone:585-820-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239837-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse