Provider Demographics
NPI:1134944077
Name:CHINCHILLA, LEAH (RN)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:CHINCHILLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 CHOCTAW LN
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8672
Mailing Address - Country:US
Mailing Address - Phone:601-540-2066
Mailing Address - Fax:
Practice Address - Street 1:4500 N LEWIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-7111
Practice Address - Country:US
Practice Address - Phone:605-606-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS914304163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse