Provider Demographics
NPI:1851530661
Name:CHOTKOWSKI, EARNESTINE MOORE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:EARNESTINE
Middle Name:MOORE
Last Name:CHOTKOWSKI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 CONNER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2081
Mailing Address - Country:US
Mailing Address - Phone:618-223-1020
Mailing Address - Fax:
Practice Address - Street 1:6939 CONNER POINTE DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2081
Practice Address - Country:US
Practice Address - Phone:618-223-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002030426163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice