Provider Demographics
NPI:1073261608
Name:CHWALISZEWSKI, JOSEPH LEE (LPN)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
Last Name:CHWALISZEWSKI
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14900 N PENNSYLVANIA AVE APT 1437
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-5911
Mailing Address - Country:US
Mailing Address - Phone:405-313-7857
Mailing Address - Fax:
Practice Address - Street 1:1737 LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5033
Practice Address - Country:US
Practice Address - Phone:405-313-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327248164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse