Provider Demographics
NPI:1053064147
Name:CHOPANE, WANNETTA (LVN)
Entity Type:Individual
Prefix:
First Name:WANNETTA
Middle Name:
Last Name:CHOPANE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BENMAR DR STE 3325
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3127
Mailing Address - Country:US
Mailing Address - Phone:281-936-1021
Mailing Address - Fax:346-344-0204
Practice Address - Street 1:440 BENMAR DR STE 3325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3127
Practice Address - Country:US
Practice Address - Phone:281-936-1021
Practice Address - Fax:346-344-0204
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188863164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty