Provider Demographics
NPI:1639603863
Name:AYERS, CHANEL
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:AYERS
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 1:1465 SHERIDAN RD
Mailing Address - Street 2:APT 1
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4444
Mailing Address - Country:US
Mailing Address - Phone:262-744-8097
Mailing Address - Fax:
Practice Address - Street 1:1465 SHERIDAN RD
Practice Address - Street 2:APT 1
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4444
Practice Address - Country:US
Practice Address - Phone:262-744-8097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI321506164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse