Provider Demographics
NPI:1871639575
Name:CHACKO, TESSYKUTTY (LVN)
Entity Type:Individual
Prefix:MRS
First Name:TESSYKUTTY
Middle Name:
Last Name:CHACKO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 ZINFANDEL CIR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3259
Mailing Address - Country:US
Mailing Address - Phone:831-439-9811
Mailing Address - Fax:
Practice Address - Street 1:158 ZINFANDEL CIR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3259
Practice Address - Country:US
Practice Address - Phone:831-439-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN159597164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse