Provider Demographics
NPI:1407846355
Name:CHINNETH, ILUMINADA S (ARNP)
Entity Type:Individual
Prefix:
First Name:ILUMINADA
Middle Name:S
Last Name:CHINNETH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ILUMINADA
Other - Middle Name:S
Other - Last Name:CALICDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:USAG-J, UNIT 45013
Mailing Address - Street 2:BOX 2719
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338
Mailing Address - Country:JP
Mailing Address - Phone:315-263-7832
Mailing Address - Fax:315-263-8463
Practice Address - Street 1:USAG-J, UNIT 45013
Practice Address - Street 2:BOX 2719
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96338
Practice Address - Country:JP
Practice Address - Phone:315-263-7832
Practice Address - Fax:315-263-8463
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004756171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider