Provider Demographics
NPI:1568167484
Name:SUBLETT, CHANTELLE
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:
Last Name:SUBLETT
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 1:5645 MATTESON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-4149
Mailing Address - Country:US
Mailing Address - Phone:317-701-8537
Mailing Address - Fax:317-863-1255
Practice Address - Street 1:5645 MATTESON DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-4149
Practice Address - Country:US
Practice Address - Phone:317-701-8537
Practice Address - Fax:317-863-1255
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22-014994-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health