Provider Demographics
NPI:1972277440
Name:OSWALT, CHINAH MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHINAH
Middle Name:MARIE
Last Name:OSWALT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PRINSTON ST
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-5724
Mailing Address - Country:US
Mailing Address - Phone:662-610-3842
Mailing Address - Fax:
Practice Address - Street 1:144 S THOMAS ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5312
Practice Address - Country:US
Practice Address - Phone:662-844-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS909426163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse