Provider Demographics
NPI:1679002323
Name:CHENAULT, LUCRECE
Entity Type:Individual
Prefix:
First Name:LUCRECE
Middle Name:
Last Name:CHENAULT
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 1:4400 WASHINGTON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0891
Mailing Address - Country:US
Mailing Address - Phone:270-454-3758
Mailing Address - Fax:
Practice Address - Street 1:4400 WASHINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0891
Practice Address - Country:US
Practice Address - Phone:270-454-3758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver