Provider Demographics
NPI:1669127957
Name:CHUGG-JOHNSTON, RICKELLE RENAE (LPN)
Entity type:Individual
Prefix:MISS
First Name:RICKELLE
Middle Name:RENAE
Last Name:CHUGG-JOHNSTON
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 1:93 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1330
Mailing Address - Country:US
Mailing Address - Phone:585-409-6968
Mailing Address - Fax:
Practice Address - Street 1:93 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1330
Practice Address - Country:US
Practice Address - Phone:585-409-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317747-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse