Provider Demographics
NPI:1629662168
Name:STRICKLAND, CHEVON MARVERLETTE
Entity Type:Individual
Prefix:
First Name:CHEVON
Middle Name:MARVERLETTE
Last Name:STRICKLAND
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 1:6504 PEACEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2300
Mailing Address - Country:US
Mailing Address - Phone:170-449-3309
Mailing Address - Fax:
Practice Address - Street 1:6504 PEACEHAVEN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-2300
Practice Address - Country:US
Practice Address - Phone:170-449-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC259517163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86-1954139Medicaid