Provider Demographics
NPI:1568061273
Name:CHEMPOLIL GEORGE, SHALUMOL
Entity Type:Individual
Prefix:
First Name:SHALUMOL
Middle Name:
Last Name:CHEMPOLIL GEORGE
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 1:7421 FRANKFORD RD APT 634
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-8185
Mailing Address - Country:US
Mailing Address - Phone:848-242-0636
Mailing Address - Fax:
Practice Address - Street 1:7421 FRANKFORD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-8152
Practice Address - Country:US
Practice Address - Phone:848-242-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX982279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse