Provider Demographics
NPI:1811597578
Name:CHITISHVILI, DESIRAE LEANN (CNA)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:LEANN
Last Name:CHITISHVILI
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:DESIRAE
Other - Middle Name:LEANN
Other - Last Name:FARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:US ARMY MEDICAL ACTIVITY-BAVARIA UNIT 28038, ATTN: MCEU
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US ARMY MEDICAL ACTIVITY-BAVARIA UNIT 28038
Practice Address - Street 2:ATTN: MCEU-BAV-CRE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:719-464-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00779888376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide