Provider Demographics
NPI:1003146655
Name:CHITMAN-ALLEN, SUSITA SHAWNTA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSITA
Middle Name:SHAWNTA
Last Name:CHITMAN-ALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22119 BRIDGESTONE HAWK CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4663
Mailing Address - Country:US
Mailing Address - Phone:281-433-9298
Mailing Address - Fax:
Practice Address - Street 1:22119 BRIDGESTONE HAWK CT
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4663
Practice Address - Country:US
Practice Address - Phone:281-433-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
TX704538163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide