Provider Demographics
NPI:1821262221
Name:SIAFA, CHESTER J (LPN)
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:J
Last Name:SIAFA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 BRIDLINGTON LN APT F
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3851
Mailing Address - Country:US
Mailing Address - Phone:617-888-0153
Mailing Address - Fax:
Practice Address - Street 1:2062 BRIDLINGTON LN APT F
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3851
Practice Address - Country:US
Practice Address - Phone:617-888-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.125031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse