Provider Demographics
NPI:1538504485
Name:NOP, CHETMESA MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:CHETMESA
Middle Name:MICHELLE
Last Name:NOP
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 1:4422 N PERSHING AVE STE D2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6967
Mailing Address - Country:US
Mailing Address - Phone:209-953-8843
Mailing Address - Fax:209-953-8478
Practice Address - Street 1:4422 N PERSHING AVE STE D2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6967
Practice Address - Country:US
Practice Address - Phone:209-953-8843
Practice Address - Fax:209-953-8478
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator