Provider Demographics
NPI:1255188405
Name:CHESTNUT, TANYA MICHELE (LPN)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:MICHELE
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 OLEANDER DR STE B6
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4749
Mailing Address - Country:US
Mailing Address - Phone:910-399-1096
Mailing Address - Fax:
Practice Address - Street 1:5725 OLEANDER DR STE B6
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4749
Practice Address - Country:US
Practice Address - Phone:910-399-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79715164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse