Provider Demographics
NPI:1942693940
Name:ECKERT, CHANTEL M (RN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:CHANTEL
Middle Name:M
Last Name:ECKERT
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5886
Mailing Address - Country:US
Mailing Address - Phone:315-591-1616
Mailing Address - Fax:
Practice Address - Street 1:581 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-5886
Practice Address - Country:US
Practice Address - Phone:315-591-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22524289163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse