Provider Demographics
NPI:1821470758
Name:RICKETTS-EDWARDS, CHANTEL (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:
Last Name:RICKETTS-EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CHANTEL
Other - Middle Name:
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:320 E 94TH ST
Mailing Address - Street 2:APARTMENT 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1853
Mailing Address - Country:US
Mailing Address - Phone:347-633-3487
Mailing Address - Fax:
Practice Address - Street 1:320 E 94TH ST
Practice Address - Street 2:APARTMENT 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1853
Practice Address - Country:US
Practice Address - Phone:347-633-3487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-27
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693682-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse