Provider Demographics
NPI:1013492172
Name:CHESTER, PETRINA PETERS
Entity Type:Individual
Prefix:MRS
First Name:PETRINA
Middle Name:PETERS
Last Name:CHESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4827
Mailing Address - Country:US
Mailing Address - Phone:504-583-8895
Mailing Address - Fax:985-265-4402
Practice Address - Street 1:2043 HEATHER LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4827
Practice Address - Country:US
Practice Address - Phone:504-583-8895
Practice Address - Fax:985-265-4402
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)