Provider Demographics
NPI:1265581243
Name:CHMIELEWSKI, CHRISTINE (ATC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CHMIELEWSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 GERBER CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1411
Mailing Address - Country:US
Mailing Address - Phone:904-899-3366
Mailing Address - Fax:
Practice Address - Street 1:4555 EMERSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4966
Practice Address - Country:US
Practice Address - Phone:904-633-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL1178246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other