Provider Demographics
NPI:1467938027
Name:CHANSOULME, LIS
Entity Type:Individual
Prefix:
First Name:LIS
Middle Name:
Last Name:CHANSOULME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 KILLARNEY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6807
Mailing Address - Country:US
Mailing Address - Phone:702-689-8026
Mailing Address - Fax:702-633-5895
Practice Address - Street 1:5058 KILLARNEY ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6807
Practice Address - Country:US
Practice Address - Phone:702-689-8026
Practice Address - Fax:702-633-5895
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant