Provider Demographics
NPI:1568145969
Name:NIBERT, CHANDRA LYNN
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:LYNN
Last Name:NIBERT
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 1:1509 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1203
Mailing Address - Country:US
Mailing Address - Phone:440-654-7189
Mailing Address - Fax:
Practice Address - Street 1:1509 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1203
Practice Address - Country:US
Practice Address - Phone:440-654-7189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376708650797376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide